Did wink provoke brutal assault?

By Alicia Gallegos
Tribune Staff Writer

Thursday,April 5, 2007
Edition: MARS, Section: nation, Page A1

SOUTH BEND — Hazel Salinas remembers tearfully looking down at her fiancee Jose Contretras last week before he was whisked away into surgery.

The beating Contretras allegedly suffered at the hands of a co-worker had cracked his skull, doctors told them, causing bits of bone to lodge in his brain.

The sight of dried blood covering the man’s clothes lingered in her mind as she waited for word on his condition, she recalled Wednesday.

Amazingly, Contretras improved dramatically after doctors removed the particles and closed his skull. He was able to return home this week.

Despite relief that her fiancee is mending from the near-death experience, Salinas and her friends say they’re angry that his accused assailant already is back on the streets.

James Hinkle, 54, was charged with two counts of class C felony battery of Contretras while the two were at work Friday.

Hinkle was out of jail the day after the incident on $1,000 bond, according to jail records.

Hinkle told police he hit Contretras with a metal pole because he was annoying him, according to police reports, but Contretras said through a translator Wednesday that he had done nothing to the man.

Salinas believes the beating may have been racially motivated, and she believes Hinkle should face a stiffer penalty considering the extent of Contretras’ injuries.

“He could’ve killed him,” Salinas said during an interview at her home. “Even if he was winking his eye, is that cause for somebody to try to kill somebody?”

Police said Wednesday they have no reason to believe the incident was race-related.

The incident allegedly took place Friday afternoon at AJ Wright, 1902 West Sample St., as Hinkle and Contretras were unloading trailers.

Police reports indicate that Contretras had been “blinking his eyes” at Hinkle and “making kissing gestures,” which irritated the man.

Hinkle reportedly told another co-worker that he was going to hit Contretras if he didn’t stop. Shortly afterward, he allegedly attacked Contretras with the metal rod.

Employees Debbie Brocklehurst and her daughter Kathy Hollingsworth ran to Contretras’ aid as soon as they saw him lying on the ground.

“He wasn’t moving,” Brocklehurst remembered by phone Wednesday. “There was a lot of blood.”

Both women were shocked that Hinkle would strike the man for no apparent reason.

Because of the language barrier, Brocklehurst said Contretras often whistled and used hand signs to communicate with workers who didn’t speak Spanish.

Brocklehurst said it was just his way of communicating and no one else seemed to mind.

Contretras said Wednesday that he had never interacted with Hinkle before and that he doesn’t remember exactly what happened.

“I’m mad, ’cause I didn’t do anything to him,” he said. “I didn’t even talk to him.”

In response to a question about whether the suspect’s actions may have been racially motivated and constituted a “hate crime,” a statement released by the St. Joseph County Prosecutor’s office Wednesday states:

“There is no Indiana Criminal Statute that exists that designates a racially motivated crime as a separate offense, nor is there any Indiana Statute that enhances or aggravates an existing criminal offense or its penalties if the criminal activity is racially motivated.”

A spokeswoman for AJ Wright would not comment on the incident Wednesday.

She also said she could not confirm or deny if Hinkle still was employed by the company because it was a “police matter.”

Salinas said she was told by administrators that Hinkle no longer worked for the company.

Meanwhile, Salinas is doing her best to care for Contretras, who needed more than 13 staples to close a 7-inch gash in his head.

Contretras should make a full recovery, Salinas said, although he will have to undergo more surgery. The couple had been planning to get married later this month but had to postpone the wedding.

Right now, both said the biggest question on their minds is “why.”

“I want to know why he did this to me,” Contretras said. “He did not have (any) reason.”

Staff writer Alicia Gallegos:

agallegos@sbtinfo.com



New lead-safe rule in effect

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,April 26, 2010
Edition: mich, , Page B1

SOUTH BEND — A new federal rule aimed at lead-safe practices in older buildings could soon find contractors ill-prepared to implement the changes.

The new Environmental Protection Agency regulation, called the Renovation, Repair and Painting rule — which went into effect Thursday — requires all renovators working on homes built before 1978 to complete lead-safe practice training and certification.

But local health department officials are concerned that not enough contractors have yet been trained.

“I don’t feel as if there is a lot of awareness (of the rule),” said Megan Wright, Healthy Homes coordinator for the St. Joseph County Health Department.

Wright said the EPA was a bit slow in pushing awareness of the rule and that a lack of lead-safety trainers has led to the dilemma. According to national reports, some trade associations have alleged that fewer than 14,000 contractors have been trained thus far.

Meanwhile, the EPA has reported that more than 50,000 contractors already have been certified across the country and they expected an additional 100,000 would be approved by Thursday’s due date.

Wright is hoping that more local contractors jump on board with training, or at least start the approval process by submitting the correct form and fee.

Much of St. Joseph County will be affected by the rule, Wright said, considering almost 80 percent of housing stock in the county was built before 1978.

She adds that the rule doesn’t just apply to houses.

The new regulation specifies anyone working on homes, apartments or children-occupied facilities such as child-care centers must take an eight-hour training course and receive the approved certification. Individuals as well as firms are required to have the new credentials in order to continue operating.

Violations could result in a fine of more than $30,000 by the EPA.

Ron Perry, a contractor with the Robert Henry Corp. in South Bend who recently had the lead training, said he understands the positive effect of the rule, but he wonders about the extra cost to each job.

Alan Loeffelholz, a contractor with VanOberberghe Builders in South Bend, who also recently had the training, agreed.

“Hours are money,” he said.

Contractor Brian Burris, however, argues the new changes will not affect time and work as much as some contractors might think.

Burris, a contractor with B&E Remodeling in Mishawaka, had an intensive course in lead-safe practice training a few years ago and noted the practices only take some getting used to at the beginning.

“We contractors, we hate being told what to do,” Burris said with a laugh. “We hate change. But it seems a whole lot worse than it is.”

Supply costs for the new rule vary, with some estimates being as low as $100. Burris said the cost is more like $1,000, but that after the initial expense the cost levels off. He added the main part of the training relates to containing the work area, minimizing dust and cleaning up thoroughly.

The process take more time at the start, Burris said, but the cleanup is actually easier.

“With kids that do get so sick, it’s far worth it,” Burris said.

Health advocates agree the new rule could potentially save many children from being poisoned.

“This is long overdue and should substantially reduce the number of lead-poisoned children,” health department environmental manager Marc Nelson said in an e-mail.

Nelson pointed out that the Occupational Safety and Health Administration has historically had policies to protect people who perform work that disturbs lead, but no real protection has been provided to people actually living in the home until now.

Lead dust in homes, Wright adds, is the main source of childhood lead poisoning.

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

Law could mean pool closures

By Alicia Gallegos
Tribune Staff Writer
Source:  news
Sunday,December 21, 2008
Edition: mars, , Page B1

SOUTH BEND — With frigid temperatures outside and a constant serving of fresh snow on the ground, the thought of swimming pools is the farthest thing from most people’s minds.

But with a strict new law that went into effect last week on proper drain covers for all public pools — including high schools and recreational centers — pools have become a hot topic despite the cold climate.

The Virginia Graeme Baker Pool and Spa Safety Act was signed into law last year and is designed to prevent drain entrapments and eviscerations that have taken the lives of many children over the last few years.

The law is named for a 7-year-old Virginia girl who drowned after being held underwater by a family friend’s spa drain.

But officials with the U.S. Consumer Product Safety Commission said last week that a significant number of pools and spas across the country have not yet met the regulations and were at risk of being shut down by last Friday.

“We are concerned about the level of compliance as we come upon the deadline,” CPSC spokesman Scott Wolfson said last week. “It’s a federal law that should not be ignored.”

New drain availability and cost, however, are two factors prohibiting some compliance, operators say.

At the YMCA of Michiana, aquatics director Amy Milliman said the facility’s older model pool requires drain covers specially made to fit the size and shape of the pool. Right now, staff must wait until drain covers are built and shipped, she said.

Milliman added that although the law was passed last year, information was slow and then unclear as it reached pool operators. The regulations had two drafts, she said, the second being much stricter than the first.

“I’ve been told that we do meet the requirements; I’ve been told that we don’t meet the requirements,” she said. “It’s very confusing.”

Other facilities currently in operation also will be affected by the new law, such as hotel hot tubs and pools.

The Marriott in South Bend is one hotel that seems ahead of the curve when it comes to the new regulations, having had new drain covers on their pool and hot tub for nearly a year, said director of operations Kelly Neubauer.

The Marriott corporation was proactive in making sure all its hotels were in compliance, Neubauer said.

At least 10 other calls to local hotels were either not returned Wednesday or a reporter was told no one was available to speak about the drain issue.

At local schools, availability also seems to be a problem.

Penn-Harris-Madison School Corp. is working with an Indianapolis company to make new drain covers for the pool at Penn High School, according to spokeswoman Teresa Carroll.

“We are moving on that,” she said. “However, they do not have the products available.”

Likewise at Mishawaka schools, athletic director Bob Shriner said he was checking with supply companies on availability.

He noted, however, that larger pools such as ones used by swim teams have multiple drains and do not pose the same suction hazards that smaller pools and spas do.

Wolfson from the safety commission stressed it’s up to state and local officials to enforce the new law.

St. Joseph County Health Department officers will make note of the new drain covers or lack thereof during pool inspections, according to food supervisor Rita Hooton, but that at this time they can’t enforce the rule.

The health department has to wait until the state has adopted the new regulation into state law, she said, which officials are now in the process of doing.

To learn more

For more information about the Pool and Spa Safety Act, how to comply and which companies have been certified to manufacturer drain covers, go to http://www.cpsc.gov.

Psychiatry facing challenges

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,April 19, 2010
Edition: mich, , Page A1

When Dr. Alan Schmetzer graduated from medical school in the early 1970s, the psychiatrist saw significant opportunities for young professionals in the mental health field.

At the time, the Indiana University School of Medicine in Indianapolis — where Schmetzer currently teaches — had 12 open spots for psychiatry residents, which in turn was leading to a host of new community mental health centers opening.

Today, Schmetzer says that landscape has vastly changed. Numbers of open spots for future psychiatrists at IU and other schools have dropped by nearly half, according to the doctor, and many community health centers across Indiana are struggling financially.

Most recently, Madison Center in South Bend has had to cut positions and undergo significant restructuring under growing pressure from creditors.

To offset spaces left by resigning physicians, the local mental health facility says it plans to hire an undetermined number of temporary doctors called “locum tenens”

until they can fill full-time slots.”This is happening all over the country,” Schmetzer says of the reductions. “(But) the Midwest in particular is very short of psychiatrists.”

Indiana has some of the poorest psychiatrist rates per capita in the nation, according to Schmetzer, and the state is no stranger to financial troubles forcing mergers and shutting down mental health facilities.

Some experts have hypothesized that in the next 10 years, the number of community mental health centers in Indiana will be down to five mega-centers.

The theory is one that doctors like Schmetzer hopes never becomes reality.

Need vs. growth

Psychiatrists have long lagged behind their physician counterparts in terms of numbers, but recently doctors say that gap has extended even further.

Whether it’s more mental illness among the population or more awareness of mental illnesses, Dr. Jess Shatkin says diagnosis of conditions such as bipolar disorder and autism have increased 40-fold in the last few years.

Shatkin, director of education and training at the New York University Child Study Center and director of undergraduate studies for the Child and Adolescent Mental Health Studies, says this rise in need has put a strain on an already thin discipline.

A recent study on mental health care workers in Health Affairs magazine, for example, showed that between 1990 and 1999, the number of psychiatrists in the United States increased by only 15.2 percent, compared with a 37 percent increase in psychologists and a 17.9 percent increase in social workers.

Certain realms inside psychiatry are even more underserved, specifically child psychiatry, says Dr. Harsh K. Trivedi, executive medical director of Vanderbilt Psychiatric Hospital in Tennessee.

Trivedi says about 7,000 working child psychiatrists exist at the moment, versus a need of close to 30,000.

As the population ages, doctors specializing in geriatric psychiatry are failing to match need, adds Dr. Chris Callohan, director of the Center for Aging Research at the IU School of Medicine.

Ironically, reasons for these shortages include that doctors themselves are aging. A recent study found that more than 60 percent of psychiatrists completed their training more than 21 years ago and that only 32 percent of psychiatrists are younger than 45.

Callohan adds that premed students also aren’t finding psychiatry the most attractive option compared to other arenas. Average salaries of psychiatrists are about a third of other doctor incomes.

Rounding out the shortages are federal funding cuts that have led to fewer residency spots at schools and fewer training programs at hospitals for psychiatrists-to-be.

“There are plenty of people to be seen, that’s for sure,” Schmetzer says. “My greatest fear is my generation, the Baby Boomer one, filled all those extra slots. (Retirements) are going to leave an awful lot of openings.”

The dilemma of doctor scarcity is also met with the descending slope of community mental health facilities across the nation.

In the last few years, Indiana has faced its share of facility reorganizations because of financial trouble and tight budgets. This includes last year’s merger of Hamilton County mental-health services provider BehaviorCorp. and Anderson-based Center for Mental Health Inc.

The new nonprofit corporation, Aspire Indiana, serves residents in Madison, Hamilton, Boone and northern Marion counties.

Two more Indiana mental health facilities – the Center for Behavioral Health and Quinco Behavioral Health systems – were also recently bought out by Centerstone, Tennessee’s largest behavioral health care provider, according to business reports. The combined organizations now have more than 120 locations in Indiana and Tennessee.

And Madison Center in South Bend is experiencing serious transition because of ongoing financial issues. Madison officials insist, however, the center will not be closing anytime soon.

Fill-in doctors

With more mental health facilities struggling to survive, some, like Madison Center, are turning to alternatives to permanent doctors, at least temporarily.

Locum tenens, which in Latin essentially means “placeholder,” are temporary physicians contracted to provide fill-in services.

The locum tenens physician industry has grown by leaps and bounds over the last 10 years, according to Staff Care, one of the largest locum tenens contracting companies in the country.

In 2002, about 28,000 doctors were working on a locum tenens basis for the agency, said Staff Care spokesman Phillip Miller. That number rose to 37,000 in 2008.

Opinions on whether locum tenens are beneficial in the long term are mixed.

Schmetzer says temp doctors can be a good idea for rural areas where psychiatrists are hard to come by and access to care is significantly reduced.

But like many of the doctors interviewed for this story, he worries about continuity of care.

Patients benefit from doctors familiar with their history, he said, adding that those with persistent mental illness especially don’t deal well with change.

Trivedi agrees.

“Patients in psychiatry talk about the most detailed part of their lives,” he said. “You develop rapport with your doctor. That’s difficult if they’re leaving in a month.”

Miller, however, argues that locum tenens are far better than the alternative, which is “not to have a doctor,” and that the physicians still provide top quality care.

Credential requirements for locum tenens have become stricter over the last five years, Miller said, along with reviewing their licenses and malpractice records.

Miller said locum tenens also benefit doctors who are dissatisfied with traditional practices and dealing with processes such as insurance claims and fighting for payment reimbursement.

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

New device, less pain

By Alicia Gallegos
Tribune Staff Writer

Source: news
Wednesday,February 25, 2009
Edition: mich, , Page D1

SOUTH BEND — After performing hundreds of knee replacement surgeries, Dr. Ron Clark, a South Bend Clinic orthopedic surgeon, was troubled by the stories he heard from many patients.

Although most told him the surgery ultimately had changed their lives for the better, they also said the experience had been one of the most painful.

Clark was determined to find a way patients could have less pain after surgery and recover more quickly once they were home. Now, after years of developing a new surgical device, the doctor seems to have done just that.

The method centers on a new implant used during knee replacements that allows for smaller incisions, Clark explained during a recent interview. Incisions in traditional surgeries are about four inches long, he said, while his new procedure allows for an incision between 11/2 inch and 2 inches.

Historically, surgeons have put cement on the implant and pushed the cement against bone during the surgery, according to Clark.

The new implant has cement channels built into the device, so that doctors can attach a cement syringe to the implant and inject liquid cement directly into the implant, Clark explains. The liquid cement then flows to the bone, allowing it to hold better and bond more strongly.

Right now, Clark said, he is the only doctor in the country performing the new surgery, but not for long. He recently gave a surgical demonstration and will teach the technique during a conference later this month.

Not everyone, however, believed in Clark’s device when he first came up with the idea.

Rocky road to success

In 2005, when Clark applied for funding from the Indiana 21st Century Research and Technology Fund, to further develop his idea, he said he was rejected. A panel expert called Clark’s suggestion a “waste of time.”

So Clark employed a patent attorney and soon after founded an enterprise called Valpo Orthopedic Technologies, in Warsaw, to help him work on the design. In 2008, the new implant was approved by the Food and Drug Administration. Since December, the doctor has performed five successful surgeries with the new device, including one on Edwardsburg resident Barb Stitt.

The 45-year-old woman has degenerative joint disease along with severe arthritis, and had had five prior knee surgeries. Her throbbing knees made even trips to the grocery or gardening limited, Stitt said, and she often had to rest as soon as she was home from work.

“I walked like a 90-year-old lady,” she said. “I had a terrible limp.”

Stitt’s left knee eventually became so weak, she said, that nothing was left for her to do but have knee replacement surgery. Stitt, a South Bend Clinic allergy nurse, knew Clark and had heard about the new surgery. As soon as it was FDA-approved, Stitt said, she told the doctor, “Sign me up!” She had the surgery in January.

The operation took longer than expected, Stitt said, because of glue that did not completely adhere to the implant the first time. The second round, the implant stuck.

Clark said the complication came not from the implant, but from the surgical technique, which has been modified some since Stitt’s surgery.

As for recovery, Stitt was elated to have a much easier experience this time around. In the past, she had spent as long as six weeks recovering.

“I was able to bear weight the night of the surgery,” she said. “I healed up pretty well.” The nurse was also back to work after only a week.

“I would tell people this is an excellent procedure to have done,” Stitt said.

Another advantage, according to Clark, is cost. Traditional knee replacement runs about $30,000, compared with $10,000 for the new surgery, because less bone is removed, less bleeding occurs and physical therapy time is decreased.

The implants, Clark said, also should last longer than traditional replacements — remaining about 10 years longer than traditional implants.

Clark said an average of 5 percent of patients who receive uni-compartment knee surgery, in which only one portion of the knee is operated on, generally need a second surgery.

With the new device, that second surgery likely will come further down the road and be more bearable if it does happen, Clark said.

Stitt says she knows that eventually, she will need complete knee replacement surgery, but she believes her recent surgery has given her plenty of time before that happens.

“It’s improving every day,” she said. “I went shopping last weekend. I feel a lot better.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

How valid is a will?

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,August 24, 2009
Edition: mich, , Page A1

SOUTH BEND — It’s a legal contract no one really likes to think about going into effect.

The document where you inscribe your final wishes, listing to whom you bequest your worldly possessions and exactly how much to bestow upon them.

But though the process of writing a will seems a necessary evil, challenges to the age-old practice remain.

Recently, will conflicts have become the subject of heated lawsuits locally and nationally, sparking concerns about the validity of a person’s last testament.

Exactly how much is a will worth when the document can later be debated?

Battling beneficiaries also raise questions about the mental competency of a will’s creator and the rules in place to prevent them from unfair influence.

“When a case is contested,” says Alan F. Rothschild Jr. “It can be emotionally and financially draining.”

That’s why Rothschild, head of the Trust and Estate Division of the American Bar Association, and other law experts warn residents to take precautions.

Seeing the signs for potential will wars and planning ahead could work to protect your will and curb the likelihood of conflict after your death.

Unstable mind?

For years, 67-year-old Jerome L. Jeffers of Elkhart struggled with mental illness, according to family members and court documents.

The former patent attorney for Bayer Corp. had been diagnosed with a major depressive disorder as far back as 1991, court documents state, exhibiting mood swings and panic attacks, and trying to commit suicide.

In 2008, the married father of two reportedly started showing extreme manic behavior. Jeffers was arrested for public intoxication, compulsively bought a car, and could no longer manage bills, according to court documents.

Although he received sporadic treatment over the years, his volatile behavior eventually led to the dissolving of his 44-year marriage. Jerome and Janice Jeffers divorced in June 2008.

On Sept. 3 of that year, Jeffers admitted himself into the psychiatric ward of a Wisconsin hospital, court documents indicate, where he had abruptly moved. He discharged himself Sept. 8, 2008.

Seven days later he called his former wife and told her he planned to take an overdose of pills, according to documents.

Shortly afterward, Jeffers committed suicide by drowning in a Wisconsin lake.

Only after his death did family members learn that Jeffers had recently and drastically altered his will.

The original document, established in 2003, had listed his then-wife as the 100 percent primary beneficiary of his accounts, and his two adult daughters as 50 percent contingent beneficiaries, documents state.

But on July 11, 2008 – two months before his death – Jeffers changed those terms, giving 75 percent of his savings to the American Red Cross and 12.5 percent each to his daughters. The combined value in Jeffers’ two accounts, court documents say, was more than $1.2 million.

The will change has led to a recently filed federal lawsuit by Janice Jeffers and her daughters, Kelly and Kristen Jeffers, against The American Red Cross.

When reached by phone, Janice Jeffers said she believes her husband was not in his right mind when he made changes to the will. He had never had close ties to The American Red Cross, she said, other than sometimes giving blood to the agency.

Janice Jeffers said the Red Cross refused a mediation that might allow for a more fair distribution of the funds to her daughters. The family is also questioning if the will was changed with the proper number of witnesses.

A representative for the American Red Cross said the agency could not comment on pending legal matters. Fidelity Brokerage Services officials, also named as defendants in the suit, declined to comment as well.

Uncommon conflict

The Jeffers case is far from the only will dispute that has landed in court.

A string of recent will battles involving celebrities like Michael Jackson, James Brown and Anna Nicole Smith also have brought the subject of to the forefront.

Locally, there is also the recent case of the late Dr. Philip Gabriele, whose brother-in-law has asked a court to revoke the doctor’s will, claiming a depressed Gabriele was being unfairly influenced when he penned the document.

Gabriele and his wife, Marcella, were indicted in federal court for malpractice in June and scheduled to be arraigned the day they were found dead in an apparent murder-suicide.

Gabriele wrote the will just days before he died, giving purported best friend Susan Manuszak 75 percent of his gross estate and his mother 25 percent.

But despite all the publicity, Rothschild says, contested wills are not typical.

“In my 25 years practicing law, I would say less than one percent of wills are contested,” he said.

Local estate expert Richard B. Urda Jr., attorney and president of Urda Professional Corp. in South Bend, agrees. The disputes are “relatively rare,” says Urda, who is also a fellow with The American College of Trust and Estate Counsel.

If a will is contested, however, Urda points to three common assertions, including: that proper will procedure was not followed, that the client had decreased mental competency, or that someone exerted “undue influence” during the time of the will.

Childless couples also have a greater risk of having their wills challenged because of the broader mix of possible beneficiaries, Rothschild says.

But both experts detail some ways to prevent a will dispute, and they say it’s never too late to implement them.

Dissolving disputes

The tools are used to catch criminals, to provide building safety, and also, in recent times, to ensure will security.

They are videotapes.

Clients have had the ability to have their interactions with attorneys and estate planners recorded for years, Urda says, based on Indiana statute. A person can easily ask to have their will-signing recorded and kept for evidence.

Residents also have the option of a revocable trust, which they can put funds into. Revocable trusts in many states are much more difficult to challenge than a will, according to experts.

As for issues of mental competency, Rothschild believes that attorneys have a certain responsibility to look out for their clients, especially if something doesn’t seem right.

“I feel some personal and professional obligation to not proceed to do something if I think the person does not fully understand what I’m doing,” Rothschild said.

Asking a client additional questions or speaking further with witnesses might be necessary to be certain a client is cognizant, Rothschild said.

Urda adds that it might be warranted to ask for a family physician’s opinion about a client’s mental state if concerns arise.

And don’t forget to speak up.

If you have plans to give money to a certain charity or to significantly change your will, Rothschild says you need to let family members know.

“I think the risk of (will disputes) increases,” says Rothschild. “when it’s a surprise to people.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

Did flu shot injure arm?

By Alicia Gallegos
Tribune Staff Writer

Source: news
Friday,March 13, 2009
Edition: mich, , Page A1

SOUTH BEND — With the growing spotlight on the influenza virus, it seems to make sense that many pharmacies have joined medical centers in offering flu prevention.

Signs for free shot clinics and discounted vaccinations are a common sight in local stores come flu season. But concerns exist within the medical community about the qualifications behind those giving out these vaccinations.

A South Bend woman’s recent experience receiving a flu shot appears to highlight these worries.

Lynne Rectenwal has filed a civil lawsuit against Walgreens at 1351 N. Ironwood Drive, claiming that a flu shot she received there in October was injected at the wrong spot, leading to possible permanent arm damage.

Rectenwal declined to be interviewed for this article, but her lawyer, Jeff Stesiak, explained that their contention is that the pharmacist giving the shot aimed it too high on Rectenwal’s arm and into her bone.

“It caused serious injury,” Stesiak said. “She’s been to an orthopedic surgeon and (she) could have lasting effects.”

Walgreens spokeswoman Vivika Vergara said the company was aware of the situation but could not comment on the specific case.

But during this flu season, Vergara said more than 1 million flu shots have been given out nationally at Walgreens pharmacies, administered by pharmacists, third-party nurses and nurse practitioners.

“These health professionals were all certified and trained to administer the flu vaccine,” she said in an e-mail.

Rectenwal suffered significant pain immediately after receiving the vaccine, Stesiak said, and afterward visited a doctor.

An MRI found the shot had been given incorrectly, he said, and a doctor called the Walgreens store to speak with an official about the damage. But Stesiak says the pharmacist denied giving the shot improperly.

The flu-shot related case is not the first Stesiak says he has handled. A similar one related to a patient who had had an adverse reaction after receiving a vaccine, he said.

Health experts say these types of risks make them question the people behind the syringe at pharmacies and whether their training is enough.

Pharmacy officials, however, believe they are plenty qualified to give out the shots, and not only that, but that pharmacies stepping up to provide vaccines is a positive step toward greater access to health care.

Ready, aim, fire

The process of giving a shot might not seem difficult, says South Bend Clinic attorney and nurse Daniel Stephens.

“It sounds pretty simple: You take out a needle and stick someone,” he says. “But it’s not. It’s much more complicated.”

Those giving vaccines must be acutely aware of tissue structure and muscle depth, he explains, adding that a miscalculation could lead to infection or a possible sore at the injection site.

“Some medications are designed to go into muscle,” Stephens said. “If you inject into fat, that’s going to cause a bad reaction.”

The attorney, who has 25 years of nursing experience and now instructs new nurses, says in his opinion, injections should be left to the experts.

“Not only do nurses perform injections frequently, they are also trained in various methods of needle placement,” he says. “You can have someone inject you who occasionally gives a few shots a year, or you can have a true professional do it.”

Margaret Tomecki, a spokeswoman for the American Pharmacy Association, argues that immunization training programs for pharmacists have been developed for years and that adverse reactions to shots in pharmacies are rare.

Tomecki says the APhA recommends pharmacists not only undergo immunization training but also CPR certification.

Other medical experts, like Dr. Jesse Hsieh, a South Bend Clinic family medicine physician, sees both pros and cons to each argument.

Doctors want to see as many people immunized as possible, Hsieh said, adding that at times, stores such as Walgreens and Wal-Mart actually have greater supplies of vaccine than doctors’ offices.

On the other hand, Hsieh agreed that concerns remain about possible allergic or adverse reactions.

“I would like to make sure the person giving my patient a shot has the approved training,” he said.

Right now, 49 states allow pharmacists to give vaccines, according to Tomecki, although states differ on what types they can provide and the specific training required. New York was one of the latest states to allow pharmacists to give shots.

Legislation in the state had been stymied for years because of liability concerns by nurses and doctors, according to national reports.

In Indiana, a new set of rules for the practice has also just been mandated.

New enforcements

Historically, Indiana pharmacists have been allowed to administer flu vaccinations by a physician’s order, according to Marty Allain, director of the Indiana Board of Pharmacy.

Beginning in July 2007, they could give them as long as they were following a physician’s standing protocol, he said.

Best training practices were offered as guidelines by the board, but Allain said until 2009 none had been set in place that were able to be enforced.

The new Indiana administrative code on pharmacist immunization education includes that they must complete an immunization course approved by entities such as the Centers for Disease Control and Prevention, be certified in CPR, know appropriate injection sites and dosage, and be versed in management of adverse effects, among other things.

Allain said pharmacies offering vaccinations must also be licensed and are subject to inspection or investigation.

To his knowledge, the board director said he knows of no pharmacies in Indiana where complaints have been filed with the board for improper administering of flu shots.

Regardless of differing views on pharmacists giving out shots, the vaccinations are likely just the beginning of more routine treatments being offered at places other than doctors’ offices.

“I think we’re going to run across it more and more,” Hsieh said. “This might be the tip of the iceberg.”

Tomecki adds that the practice ultimately means physicians and pharmacists both keeping more people healthy.

“There’s many patients out there,” she said. “Sometimes patients fall through the loops of health care. It’s up to us, working together as a team.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

The Smoke Clears

From the South Bend Tribune

The smoke clears
By Alicia Gallegos
Tribune Staff Writer

Source:  news
Sunday,January 6, 2008
Edition: mich, , Page A1

SOUTH BEND

3 … 2 … 1 …

Time’s up.

Now that the days until the new year have all been crossed off, a new countdown has begun, and some bar and restaurant owners in St. Joseph County couldn’t be more upset.

In about three months, nearly 50 establishments that received an extension when the 2006 smoking ban went into effect will have to abide by the ordinance.

Based on their smaller size, those businesses had two more years to comply than their larger counterparts did.

This means dozens of neighborhood bars might be spending the bucks to section off smoking areas.

Corner coffee shops could make the choice to ban smoking or obtain a liquor license to become part bar.

But none of the decisions is that simple. They come with certain terms, conditions and stipulations. Not to mention worries.

Mom-and-pop restaurant owners are concerned about having to close if they go nonsmoking. Bar managers wonder about spending the money to separate rooms if stricter bans could come in the future.

Although some still say they will fight the restrictions, health officials stress that the time for debate is over: Countywide enforcement is on the horizon.

One thing seems certain: Regulating smoking in public places is quickly becoming a worldwide norm.

Behind the freshly arrived new year trails only newer bans and rising limits on the right to light up.

A hazy awakening

Anchor Inn manager Bill Finn had heard about the smoking ban in 2006 and remembered something about an extension being given to some places.

But he hadn’t given much thought to the issue lately.

“I just kinda forgot about it, to be honest,” he said recently.

When the ordinance passed two years ago, a total of 47 establishments received leeway until April, 10, 2008.

The break applied to food businesses with food sales of less than $450,000, and that were established before the ban.

Each affected bar and restaurant will receive a notice about the extension being up when they renew their licenses this month, according to Rita Hooton, St. Joseph County Health Department food service supervisor.

She reminded owners that the County Council passed the ordinance, and it’s the health department’s job to enforce it. The enforcement will be “complaint-based.”

Inhaling from a cigarette as he spoke recently, Finn said he’s not sure what the restaurant bar plans to do now. His customers are primarily smokers, he said, and he can’t see forbidding the practice.

“It’s ridiculous,” he said. “I think people are going to come in, have a beer, and then leave. It hurts smaller businesses.”

Finn does have some choices.

The ordinance explains that establishments can separate the smokers into another room with a floor-to-ceiling barrier.

Another alternative would be to keep the restaurant as it is but forbid anyone younger than 18 to enter.

A side dining room in the restaurant does already exist, Finn said, so sectioning off nonsmokers wouldn’t be that difficult. The manager just worries about how the detachment will affect his customers.

Been there, done that

Owner Tom Schmidt can give other managers an idea of how banning smoking affects a business.

Schmidt decided to turn the Mishawaka Brewing Company into a nonsmoking establishment in September, months before his extension was up.

The owner said he wanted to gauge the effect before he was forced to do so, or before he spent money to section off a designated area.

“Is it worth it?” he asked. “Am I going to accomplish anything?”

At first, Schmidt saw no immediate difference, he said, but as the colder months came, he noticed a negative effect on his revenue.

“We’ve lost some regular customers who don’t come in as frequently,” he said.

But Schmidt believes patronage might rise again once other patrons realize the bar is smoke-free. He has received compliments from customers and employees alike about the change, he said.

Schmidt, who quit smoking years ago, enjoys the fresh air.

“I can walk in in the morning and not choke on stale smoke,” he said.

For larger restaurant chains such as Buffalo Wild Wings, closing off the bar has worked relatively well, said Don Malin, a manager at the downtown South Bend restaurant.

“It hasn’t really affected our business,” he said. “It was pretty easy for us because of the way our restaurant is set up.”

But for smaller establishments, the rules could mean the difference between shutting down and staying open.

A futile fight?

On a recent weeknight, two friends – a smoker and a nonsmoker – conversed in harmony at an Osceola bar.

Although one held a cigarette in his hand, Bruce Guard and Nina Schosker had no problem sharing each other’s company, or their views on a change to their favorite pitstop, Mr. G’s.

Guard, the smoker, believes customers should have the choice to walk into a smoking establishment and that the terms should be up to the owner.

Schosker understands the plight of nonsmokers but feels that it takes only common courtesy on a smoker’s part to keep smoke from blowing their way.

She also would hate to be separated from the very friends she intends to socialize with, she said.

“We’re all friends here,” Schosker said. “Some smoke. Some don’t, and some respect those who don’t.”

Seated nearby at Mr. G’s was a frustrated Harold Arnold, owner of the O.C. Cafe, also in Osceola.

For Arnold’s restaurant, the ban means going completely smoke-free, since alcohol is not served.

“Most of my customers tell me they won’t be back,” he said sadly.

Arnold is talking to an attorney about possibly obtaining a liquor license for the café, but then he wouldn’t be allowed to have children eat there.

“I got to do something to keep my customers happy,” he said.

Separating Mr. G’s with a glass divider is a plan that owner Kevin Candler is now considering, although he’s not happy with the idea.

A separate room already exists, but Candler worries about bands that perform at the bar and whether the entire restaurant can still be cleared out for a nightclub.

Rather fight than switch

Candler’s friend Larry Wolfe, who owns the Blue Lantern on McKinley Avenue, is dead set against the ban.

Wolfe, who is also state director of the Indiana Licensed Beverage Association, said he has no intention of changing his bar and wants to file a discrimination suit against the county.

“I’m gonna fight ’em,” he said, adding that he plans to speak to his attorney and the ILBA soon about filing suit.

But county food supervisor Hooton said fighting the ban is pointless, considering it’s already in effect.

“They can’t,” she said. “It’s done.”

Meanwhile, Candler expressed concerns that after throwing down $20,000 for glass barriers, future restrictions could render the effort useless.

With states like Illinois going completely smoke-free in 2008, the owner’s fear could certainly come true.

Mishawaka Brewing Company owner Schmidt said it’s clear the days of smoking freedom are abruptly ending. “It’s coming,” he said. “It’s just the times.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com

Are Meth Prison Sentences Given Fairly?

By Alicia Gallegos Tribune Staff Writer Source:  news Sunday,June 21, 2009 Edition: mars, , Page C1 SOUTH BEND — Unlike some drugs that are most harmful after being ingested, authorities say methamphetamine produces an inherent two-fold danger. Before the narcotic enters the body comes the unique process of manufacturing the drug, which Indiana State Police trooper Maggie Shortt says involves the same toxic chemicals as do explosives. “In essence, it’s pretty much the scope of things they use to make bombs with,” Shortt said. But because of this added risk to the public, are prison sentences for meth makers becoming more severe than in other drug cases? Earlier this week, the high-profile cases of two former Elkhart teachers accused of producing meth in their South Bend home came to an end, with both sisters sentenced to prison terms. Twin sisters Maria and Michelle Stancati pleaded guilty last month to manufacturing meth after a fire led to the lab’s discovery. Shortt, who works with the State Police meth suppression unit and testified at the sisters’ sentencing hearing, said the operation was one of the largest she had seen in St. Joseph County. Michelle Stancati, 36, was sentenced to 40 years in prison, with 20 years suspended and 20 years to serve. With day-for-day credit for good behavior, she could spend close to 10 years behind bars. Twin sister Maria Stancati, who was said to have been less involved with the production than Michelle, was sentenced to a 32-year term, all of which was suspended. But as a “condition of probation,” she was ordered to serve 20 years in prison with a chance for a sentence modification after one year. This means that after 12 months, Maria could be allowed to serve the rest of her probation out of prison if the judge allows. Shortt said she believes the women’s backgrounds affected their fate. “I think a lot of it had to do with (that) they were teachers,” she said. “and that after the first lab in November, they’ve broken the law since. “That sure didn’t help them.” After posting bond, Maria was later arrested and charged in St. Joseph County with operating a vehicle while intoxicated. She was sentenced to 65 days of incarceration for that offense. Michelle later was arrested in Elkhart County for meth manufacturing in another case that is pending. St. Joseph Superior Court Judge Jerome Frese mentioned both additional offenses during the sisters’ sentencing hearing. “You bring a history with you and it is disturbing,” Frese told Maria. “I don’t know if you’re in control.” Frese told Michelle that the fact that an 11-year-old boy was living at her home during the meth production was “outrageous.” “You were clearly out of your right mind,” he said. “You created the circumstances that could have destroyed everyone in the damn house.” While the state was asking for 26-year executed sentences for both Maria and Michelle, the Stancati sisters’ attorney was asking for the minimum. William Stanley spoke of “two young ladies” who were highly educated, but made poor choices and wished to rehabilitate themselves. When reached after the hearing, Stanley said he had no specific comment on the final sentences but that he believed Frese made a sincere effort to give fair and equitable sentences to his clients. Family members of the Stancati family did not return a phone call seeking more comment for this story. St. Joseph County Prosecutor Michael Dvorak also did not want to comment on the specific Stancati case. In general, he said, meth case sentences in St. Joseph County have been consistent with other drug cases, meeting the same severity. In fact, Dvorak pointed out, in 2001, the legislature passed a bill requiring equal footing for meth and cocaine offenses. The bill made the criminal penalty for dealing in methamphetamine equivalent to the penalty for dealing in cocaine and made conforming changes to other statutes relating to cocaine and narcotic drug offenses to incorporate offenses relating to methamphetamine. “I think our courts treat meth and cocaine at sentencing as they should,” he said. Dvorak added that many factors in a trial court affect a sentence and the circumstances surrounding cases constantly differ. “It’s not just the offense,” he said. “It’s the people being sentenced.” Recovery in prison As she addressed the court during her sentencing, Michelle Stancati said she would be the first to admit that she was a meth addict. As part of his statement to Frese, her attorney also asked the judge to recommend Michelle Stancati receive an appropriate substance abuse program while incarcerated. Usually, substance abuse programs are afforded only to prisoners close to being released, but Stanley asked for Michelle to be allowed into a program sooner. Frese granted the recommendation. Michelle also happens to be in a state with a nationally renowned corrections program for meth abusers. In 2008, the Indiana Department of Corrections won a national offender program award for their intensive substance abuse treatment program called “Clean Lifestyle is Freedom Forever” or CLIFF. The program was developed close to three years ago, said IDOC communications chief Doug Garrison, after prison officials saw an increasing number of offenders as a result of meth abuse. Garrison said the recidivism rate for meth abusers who undergo the treatment has gone done by 20 percent. Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368 (574) 235-6368

Kingswood subdivision spraying called off

From the South Bend Tribune

Kingswood subdivision spraying called off By Alicia Gallegos Tribune Staff Writer Source:  news Wednesday,September 12, 2007 Edition: mich, , Page A1

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SOUTH BEND — The debate over the best way to rid neighborhoods of pesky mosquitoes has raised concerns for one south-side subdivision about whether the spraying of pesticides is safe.

Although some residents are convinced the chemical in question — Dibrom — is dangerous, health officials say the pesticide has been used safely for years.

“It is a registered chemical and has been for decades,” Dale Kemery, a press officer with the U.S. Environmental Protection Agency said by e-mail Monday.

“It is one of several widely used mosquitocides.”

The Dibrom debate started last week when residents in Kingswood Estates, just east of Miami Road, learned their homeowners’ association was planning a pesticide spray without their approval.

Resident Angel Konkey said she received only a call that the spraying was happening, saying to keep their children and pets inside.

“My concerns are all the residue that would be left on picnic tables, roofs, play equipment,” she said. “It’s not something that just goes into the ground and disappears.”

Konkey added that the chemical spraying should have been a neighborhood judgment.

Board members say they were acting in the best interest of the subdivision to deal with the severe infestation and that side effects of the chemical are now being overexaggerated.

“It’s used all over the country,” said board member Dave Raines. “We didn’t think it was that big of a deal. You want to talk about chemicals – they’re everywhere.”

The spraying was called off after neighborhood complaints, according to board President Joe Przygoda.

“Once there was opposition, we shut down the idea,” he said. “You know, we were trying to do something good. We figured let’s get everyone walking the streets again.”

But resident Elizabeth Lowenhar said she and others immediately had questions about just who has permission to spray a subdivision and what kind of notification is required.

“I thought, this just isn’t right,” she said. “Are residents allowed to do this?”

Spraying of pesticides requires a license by the Indiana state chemist’s office at Purdue University, an organization that regulates pesticides.

David Eby, owner of Agriflite Services, the company hired to spray the subdivision is licensed to dispense the chemical, according to George Saxton, a state compliance officer for the office.

Saxton said there are no state restrictions on Dibrom or notification requirements and that any safety warnings come from the chemical’s label.

“It’s all driven by the label directions,” he said. “It’s very important to get a copy of that label.”

A copy of the label, found at http://www.amvacchemical.com, warns that humans and animals should keep the chemical away from skin and eyes and that the pesticide can be toxic to fish and wildlife.

Kemery referred to an EPA fact sheet for safety evaluations which cites:

“The EPA has estimated the exposure and risks to both adults and children posed by ULV aerial and ground applications of (Dibrom). Because of the very small amount of active ingredient released per acre of ground, the estimates found that for all scenarios considered, exposures were hundreds or even thousands of times below an amount that might pose a health concern.”

However, high doses of the chemical can affect the nervous system causing nausea, dizziness, or confusion, according to EPA reports, and severe poisoning can cause respiratory problems and death.

Saxton said his office investigates any complaints or illnesses related to pesticide spraying, but that he was not aware of any concerning Dibrom in the state.

He has heard more about West Nile concerns in the area when it comes to mosquitoes, he said.

But residents like Konkey stress that in a subdivision world where residents are asked to vote on such things as “what color their shed should be,” a decision on falling chemicals is one that should include everyone.

And if she were asked, she would have said, “No.”

“I’m much more confident with putting on repellent myself,” she said. “That’s been fine.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368