The CDC’s National Healthcare Safety Network (NHSN) (If you think we have too many governmental organizations now, just wait) has compiled its first (Yes, first) State-Specific Summary and Report on Healthcare-Associated Infections.

The results of the NHSN’s 18 page (including references) report are not entirely clear.  However there are [...]]]> Source:  US Centers for Disease Control & Prevention

The CDC’s National Healthcare Safety Network (NHSN) (If you think we have too many governmental organizations now, just wait) has compiled its first (Yes, first) State-Specific Summary and Report on Healthcare-Associated Infections.

The results of the NHSN’s 18 page (including references) report are not entirely clear.  However there are some interesting things which can be discerned from the Government-speak and statistical analysis.  Between January of 2009 and June of 2009 (That’s 6 months)  The State of New Jersey reported 72 central line-associated bloodstream infections from 100 different healthcare facilities in the state. The facilities are not specifically identified in the report.  Neither do we know, for example, if 1 or 2 of those facilities accounted for the majority of the 72 blood stream infections from central-lines.

During the same time frame, the Commonwealth of Pennsylvania reported 204 central line-associated bloodstream infections from 253 different healthcare facilities. You may be wondering how this compares with infections in the State of Rhode Island.  Well Rhode Island reported only 1-4 central line-associated bloodstream infections from 16 healthcare facilities between January 2009 and June 2009.  New York reported 182 central line-associated bloodstream infections from 182 facilities.

Here’s where it gets interesting.  Well to us anyway.  Between January 2009 and June 2009, 818 hospital-associated infections were observed in the Commonwealth of Pennsylvania. Oddly, the NHSN predicted that number would be 1,176.83 which at first glance might suggest that Pennsylvania hospitals are doing something right.  That is until you recognize that there were 818 hospital-associated infections observed and who knows how many others might have been unobserved or unreported as hospital-associated infections.

During the same time frame, the State of New Jersey reported 183 observed hospital-associated infections which was close to the predicted 222.97.

So what does this all mean?  First of all, the report is the result of a limited mandate to report specifically on central line-associated blood stream infections.  Although it is clear from the total number of observed infections in the report that more types of infections were reported.

The back story: From June 2008 to December 2008, Pennsylvania’s own Department of Health reported 13,771 hospital-acquired infections, the most common were Urinary Tract Infections from catheters (UTI’s) (24.83%), surgical site infections (22.23%) and intestinal infections (18.15%).  So why is the CDC concerned only with central line-associated blood stream infections?  Good question.  30% of Pennsylvania hospitals using central lines had more infections than expected as compared with the rest of the US. Therefore Pennsylvania was flagged for reporting.

The State of New Jersey, late to the infection reporting party, only implemented legislation requiring reporting in 2007.  Accordingly, the NJ Department of Health and Senior Services first report on State hospital-associated infections will not be released until the end of 2010.  We await that report.

~Posted by D.M. Schwadron, Esquire

The US Department of Health and Human Services is a broad agency.  One of it’s charges is the administration of Medicare and Medicaid.  In this time of financial unrest, one of the measures taken by the Department is to reduce the amount of reimbursement to [...]]]> Source:  The US Centers for Medicare & Medicaid Services (CMS)

The US Department of Health and Human Services is a broad agency.  One of it’s charges is the administration of Medicare and Medicaid.  In this time of financial unrest, one of the measures taken by the Department is to reduce the amount of reimbursement to hospitals.  How does one do that?  by identifying things which occur in hospitals that are “reasonably preventable” of course.  Let’s review the Government’s own top 10 list of HAC’s or Hospital Acquired Conditions.

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are:  (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.

The Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision.  The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

The 10 categories of HACs include:

1. Foreign Object Retained After Surgery (Seriously? Still number 1 after all these years?)
2. Air Embolism
3. Blood Incompatibility
4. Stage III and IV Pressure Ulcers (Also a big Nursing Home Issue)
5. Falls and Trauma
   • Fractures
   • Dislocations
   • Intracranial Injuries
   • Crushing Injuries
   • Burns
   • Electric Shock
6. Manifestations of Poor Glycemic Control  (If you’re in the hospital they should be controlling this)
   • Diabetic Ketoacidosis
   • Nonketotic Hyperosmolar Coma
   • Hypoglycemic Coma
   • Secondary Diabetes with Ketoacidosis
   • Secondary Diabetes with Hyperosmolarity
7. Catheter-Associated Urinary Tract Infection (Common and preventable)
8. Vascular Catheter-Associated Infection
9. Surgical Site Infection Following:
   • Coronary Artery Bypass Graft (CABG) – Mediastinitis
   • Bariatric Surgery
     • Laparoscopic Gastric Bypass
     • Gastroenterostomy
     • Laparoscopic Gastric Restrictive Surgery
   • Orthopedic Procedures
     • Spine
     • Neck
     • Shoulder
     • Elbow
10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

We aren’t suggesting that everything hospitals do is incorrect.  However, if the US Government is limiting reimbursement or withholding reimbursement to hospitals when these incidents occur then it may be a good indicator that a hospital has committed an act of malpractice.

~Posted by D.M. Schwadron, Esquire

A Duke University study published in the American Journal of Roentgenology (that’s x-rays) found that plain x-rays miss a surprising amount of fractures compared with MRI.  How many?  Out of 92 patients undergoing x-ray and then checked with MRI, 35 fractures were missed.  That’s more than 1/3 of fractures [...]]]> Source:  American Journal of Roentgenology; BBC Health

A Duke University study published in the American Journal of Roentgenology (that’s x-rays) found that plain x-rays miss a surprising amount of fractures compared with MRI.  How many?  Out of 92 patients undergoing x-ray and then checked with MRI, 35 fractures were missed.  That’s more than 1/3 of fractures for the slow at math.  Oh and 11 patients had a fracture suggested by x-ray that wasn’t on the MRI (a false positive).

The problem? Well outside of the obvious, is that a negative finding read on an x-ray will not result in any additional study.  In a Hospital Emergency Room Setting, the goal is to rule out traumatic fractures and move on to other diagnoses.  Which means that patients are getting sent home with fractures that could potentially result in greater injury (ie. risk of fall, accident, extension of fracture, etc).

The suggestion of the authors was to use MRI in addition to x-rays, where doctors have doubts -particularly in the frail or elderly patient population.  (Like you, I was looking to see if the study was funded by the MRI Manufacturers Association, but I could neither confirm nor deny that.) Hip and pelvic fractures are common among this group.  (Who else thinks putting the call back upon the doctor is an inherently good idea?)  Maybe I’m missing something (no pun intended) but if ER doctors are using x-ray to rule out fracture, why would they go any further once they get a negative result.  Further, won’t the hospital administration and the Insurance Companies question the diagnostic rationale of obtaining an additional study when the first study was negative?

Okay, here is the point where I go off on an associated tangent, but a tangent, nonetheless.  The point of this study was to use MRI as a back up where there were questions about an x-ray finding.  Maybe the better practice would be to simply use MRI as the first study and do away with conventional and, apparently out-dated, x-ray technology?

What do I mean by “outdated?”  A quick history lesson.  It was 11/08/1895 when Wilhelm Conrad Röntgen accidentally discovered an image cast from his cathode ray generator.  A week after his discovery, Rontgen took an X-ray photograph of his wife’s hand which clearly revealed her wedding ring and her bones. The photograph electrified the general public and aroused great scientific interest in the new form of radiation. Röntgen named the new form of radiation X-radiation (X standing for “Unknown”).  Wilhelm’s wife, who served as chief tester would later die of radiation over-exposure.  In 1913, William Coolidge invented the X-ray tube which then revolutionized the generation of X-rays and is the model upon which all X-ray tubes for medical applications are based.  I’d consider that outdated.  Hey, what do I know, I’m a lawyer, not a doctor.

~Posted by D.M. Schwadron, Esquire

Roughly equivalent to our JCoHA (Joint Commission) here in the US, the NPSA has been taking notes on the administration of medications in English and Welsh Hospitals.  Their findings?  In every hospital in England and Wales, there were reports of patients not receiving their medications on time or [...]]]> Source: BBC Health; National Patient Safety Agency (NPSA)

Roughly equivalent to our JCoHA (Joint Commission) here in the US, the NPSA has been taking notes on the administration of medications in English and Welsh Hospitals.  Their findings?  In every hospital in England and Wales, there were reports of patients not receiving their medications on time or at all.

From 9/06 to 6/09, the NPSA recorded reports of 68 cases of severe injury and 27 deaths with an additional 21,000 cases of drug administration delays or non-administration.  Since reports to the NPSA are voluntary, the organization believes that these figures are underestimated.

Alarmingly, antibiotics (drugs to treat infection) and anticoagulants (blood thinners) and cardiac drugs are the most likely to harm patients if missed.  Although even antidepressants and Parkinson’s Disease drugs can have dramatic effects upon patient wellness if they are not timely received.

And if this is happening in England and Wales, consider the implications for an area as populated as the US with all of its hospitals and nursing home facilities.

~Posted by D.M. Schwadron, Esquire

Apparently stopping death or irreparable damage from a heart attack could be as simple as inflating a blood pressure cuff.  This according to a recent Danish (The Country) study.

How does it work and why does no one seem to know about this?  Well, it is thought that a brief stoppage [...]]]> Source: U.S. National Institutes of Health

Apparently stopping death or irreparable damage from a heart attack could be as simple as inflating a blood pressure cuff.  This according to a recent Danish (The Country) study.

How does it work and why does no one seem to know about this?  Well, it is thought that a brief stoppage of blood flow improves the ability of organs to withstand stress and prevents tissue damage.  The admittedly small study of 142 patients rushed to hospital emergency rooms for heart attacks who received this treatment managed to retain 30% more of their heart tissue than those who did not.  The cuff was inflated for 4 minutes, relaxed and then inflated again.  Repeating this procedure 4 times appears to have done the trick according to the study’s author, Dr. Hans Erik Botker, a professor of cardiology.

Unfortunately it may take some time before the rest of the world adopts the European model of treatment. One group at Emory University in Atlanta is currently attempting similar treatment here in the United States.  Dr. Jacob Vinten-Johansen has added the inflation variation with a balloon catheter, slightly more invasive.  According to Dr. Vinten-Johansen, “The United States cardiology community is a bit slower to embrace these things and the regulatory situation is better in Europe.”

Regulations here in the States require a consent for what is deemed an “experimental procedure.”  Not always something easy to obtain (No, not because of trial lawyers) as patients having heart attacks aren’t necessarily able to provide a consent.  Similar techniques are being used to attempt to treat stroke as well.

~Posted by D.M. Schwadron, Esquire

Pediatric respiratory emergencies result from a variety of causes, including chronic medical conditions, infections, allergic reactions, and obstruction from foreign bodies. At the American Academy of Emergency Medicine, held February 15 to 17 in Las Vegas, Nevada, management of the pediatric patient with a respiratory emergency and [...]]]> Source:  Medscape Medical News

Pediatric respiratory emergencies result from a variety of causes, including chronic medical conditions, infections, allergic reactions, and obstruction from foreign bodies. At the American Academy of Emergency Medicine, held February 15 to 17 in Las Vegas, Nevada, management of the pediatric patient with a respiratory emergency and some of the hidden and potentially life-threatening causes of respiratory distress was one of the educational tracks.

In this interview, MedscapeEmergency Medicine discussed the topic with Karen Santucci, MD. Dr. Santucci is medical director and section chief of pediatric emergency medicine at Yale-New Haven Children’s Hospital and is associate professor of pediatrics at the Yale University School of Medicine in New Haven, Connecticut.

Medscape: What do you look for first when a pediatric patient presents to you in respiratory distress?

Dr. Santucci: The first thing I do is a very careful physical exam. Oddly enough, sometimes you can do your best physical starting outside the exam room. Pediatric emergency medicine is a little bit different from adult emergency medicine, in that there’s a huge anxiety component, particularly in older infants and younger toddlers. Sometimes I pause outside the exam room for 5 or 6 seconds just to get a look at the status of the child in terms of increased work of breathing, because once you walk into the room, you introduce a new variable in terms of frightening the kid to death.

You can get a good sense of their baseline respiratory rate and what their affect looks like. Are they frightened because they have a partial airway obstruction or because they are really having a lot of difficulty breathing, or are they frightened because you just walked in the room and they associate any of us in healthcare with an immunization, a needle? There’s a huge fear factor.

So standing outside the room, getting a sense of how they’re interacting in their comfort zone with their family member and whether or not they’re manifesting any head bobbing, which would be movement of their head with every respiration, which would be an indication of increased work of breathing and accessory muscle use, and if they might even have nasal flaring, which is also evidence of severe respiratory distress. The physical exam is certainly critical, but I think it starts outside the exam room.

And then doing a good lung exam and observing how they’re moving air, using all your senses in terms of whether you hear stridor. Is there evidence of congestion? Is there audible wheezing? Feeling them in terms of their capillary refill, tapping on their nail bed, seeing how long it takes to refill, feeling their distal extremities, whether or not they’re warm and well perfused or cool, because children are at increased risk of becoming dehydrated with respiratory distress because of insensible losses. Certainly, if they’re manifesting with a fever, they’ll also have increased insensible losses, and they’re more at increased risk of dehydration.

Medscape: Once you’ve gone through the physical exam findings, are there any questions or particular areas you focus on when taking the history of a pediatric patient?

Dr. Santucci: One of the major things that tends to be missed in pediatrics is asking about potential risk for a foreign-body exposure, and I probably spend half of the talk on that because it is so pediatric-specific in terms of occult exposure to a foreign body that could have been missed.

Medscape: Is there a risk of clinicians becoming complacent and missing the less common causes of obstruction?

Dr. Santucci: A lot of what we see in terms of respiratory distress is associated with more common things; for example, at this time of year — January, February — we’re seeing a lot of [respiratory syncytial virus]–related bronchiolitis, particularly in children less than 2 years of age. What I would caution the clinician about is tending to think, it’s bronchiolitis season, so if an infant or toddler is presenting with respiratory distress, it’s probably bronchiolitis. I think maintaining the possibility of it being something else is so critically important.

Increased work of breathing and some congestion, and a little bit of a wheeze . . . could also be something like an inborn error of metabolism, and the child is actually presenting with what appears to be increased work of breathing because they’re developing increased respiratory drive to compensate for a metabolic acidosis.

In one case we had, what was felt to be bronchiolitis in a 10-month old was actually a salicylate overdose secondary to a mother giving increased amounts of Maalox Extra Strength for gastroesophageal reflux. We discovered that this baby had an increased anion gap . . . and, had we not erred on the side of sending a tox screen and had not this been recognized in real time, this child would have died. . . . Ask about over-the-counter meds and ointments and preparations because they can kill an individual — so [that is] very significant information.

One of the hugest points that I’ve learned over the years is maintaining a differential diagnosis when the points don’t seem to fit, delving and asking some questions, maybe sending a few extra labs to err on the side of being overly cautious and not just accepting things at face value. Even if you can’t figure things out in the emergency department, sharing that you’re really perplexed by a patient with the accepting team upstairs when you’re admitting a patient and making sure that they follow up on the lab tests as quickly as possible and initiate a pretty comprehensive work-up can absolutely be life saving.

Medscape: What are some of the tools that physicians can use to work through and manage respiratory distress in children?

Dr. Santucci: One specific case was a case of a 4-year-old girl presenting in the winter with some stridor, and she had some tripodding, which means she was leaning forward because she was trying to maximize airflow through the upper airway, and she was febrile to 104 degrees. This was a little girl who presented with all the classic signs and symptoms of epiglottitis. Even at a major tertiary-care center, there were specialists who just didn’t believe in epiglottitis any more. Ever since we’ve introduced Haemophilus influenzae type B vaccination, and this has become routine, we have reduced the incidence of epiglottitis so immensely that many people in healthcare don’t believe that it exists anymore.

The [attending ENT] was able to successfully intubate her in the operating room, but she clearly had epiglottitis and a near-complete airway obstruction, because the epiglottis was so inflamed and swollen, so edematous. The only way they were able to secure her airway on direct laryngoscopy was to squeeze her thorax and create a small air bubble. This could be a life-saving technique if you can’t get the child to the operating room, to squeeze the chest. While you’re doing direct laryngoscopy, there can be an air bubble, which will delineate where to pass the endotracheal tube.

Medscape: Besides H influenzae type B, are there other organisms that can cause epiglottitis?

Dr. Santucci: We almost always attribute it to H influenzae type B, but there are other types of bacteria — Staphylococcus, Streptococcus, and other serotypes of H influenzae — that can cause epiglottitis. Quite amazingly, there are other etiologies for epiglottitis — inhalational if someone is inhaling different types of illicit drugs. We’ve had a couple of cases associated with cold weather where people will take a gulp of some hot chocolate while they’re outside, and this thermal injury to the epiglottis will cause inflammation of the epiglottis.

So epiglottitis is still out there. We still need to maintain an index of suspicion for this, just like with foreign bodies. If you don’t think about it, you’re going to miss it, and someone’s going to die.

Have an index of suspicion for things like foreign bodies, and what kids are doing. They like to put stuff in their mouths, and so that’s a huge risk factor for morbidity and mortality if it’s not recognized early.

Medscape: Can a child’s activities before coming to the emergency department raise your suspicion of a foreign body?

Dr. Santucci: When you have a really sick kid, a lot of people mobilize, and they want to be at the bedside, but one thing that I’ve learned over the last couple of decades is that having a person break off from the bedside to talk to the family . . . it can be life-saving just to take a moment to go back and do a really thorough history.

Medscape: To wrap things up, can you give me a couple of bullet points that a physician should keep in mind when seeing a child in respiratory distress?

Dr. Santucci: An increased respiratory rate is not always a respiratory problem, so remember that tachypnea is not always a respiratory etiology and that sometimes that increase in respiratory rate is because of a compensatory mechanism for a metabolic problem. Propionic acidemia [propionyl-CoA carboxylase deficiency] is one example, and another would be diabetic ketoacidosis. Another thing is to remember the developmental status of children, particularly older infants and toddlers, and that whole foreign-body spectrum.

With regard to increased respiratory rate and increased work of breathing, when someone is presenting with acute anaphylaxis and severe allergic reaction, all the studies support getting epinephrine in within the first 30 minutes — it can absolutely save a life. If you delay that intramuscular injection of epinephrine, the cascade has already taken place in terms of what’s going on chemically, and you may have irreversible anaphylaxis. If you’re thinking about epinephrine, it would be better to give the epinephrine than to delay it.

We do not give the epinephrine intravenously. We give it intramuscularly. It’s going to be absorbed very nicely from an [intramuscular] route, and it’s extremely safe to give it intramuscularly.

Even in adults, giving intramuscular epinephrine is really quite safe. Anaphylaxis absolutely affects the heart as well, and if you don’t treat the anaphylaxis, someone might actually develop an acute myocardial infarct because of the anaphylaxis and the strain on the myocardium. So when you weigh all the pros and cons, you’re better off erring on the side of giving the epinephrine intramuscularly. That’s a huge critical life-saving point.

The FDA is taking initiative to reduce the risks of injury associated with “unnecessary” radiation exposure from CT (Computed Tomography), nuclear medicine and fluoroscopy.

Unlike traditional x-rays and mammography for which radiation doses have decreased over the years, the amount of radiation from medical imaging from the above has [...]]]> Source:  U.S. Food & Drug Administration Press Release

The FDA is taking initiative to reduce the risks of injury associated with “unnecessary” radiation exposure from CT (Computed Tomography), nuclear medicine and fluoroscopy.

Unlike traditional x-rays and mammography for which radiation doses have decreased over the years, the amount of radiation from medical imaging from the above has increased.  Accidental over-exposure can increase the risk of cancer, cause skin burns, hair loss and the formation of cataracts.   A CT of the abdomen reveals more information than a plain x-ray.  It also has the same dose as 400 x-ray studies.

The initiate by the FDA is designed to: 1.)  Promote the safe use of medical imaging; 2.) Support informed clinical decision-making; and, 3.) Increase patient awareness of exposure.   With regard to manufacturers of medical scanning equipment, the FDA intends to introduce target requirements for safeguards and provide better product training to reduce “accidental” overexposure.

Other aspects of the initiative include additional quality assurance and accreditation for Medicare and Medicaid providers.  Let’s hope they get it right.

~Posted by D.M. Schwadron, Esquire

As Amended on January 7, 2010

Because some of you asked and I listen. And there’s more than a few of you using marijuana a little too compassionately, but that’s not a value judgment.

NJ’s governor has now signed the NJ compassionate use medical marijuana act into law.  [...]]]> Source: Assembly Subcommittee No. 804, State of NJ 213th Legislature

As Amended on January 7, 2010

Because some of you asked and I listen. And there’s more than a few of you using marijuana a little too compassionately, but that’s not a value judgment.

NJ’s governor has now signed the NJ compassionate use medical marijuana act into law.  Apparently NJ, still reeling from debt, despite redonkulous property taxes, couldn’t afford to put any prepositions into the name of the Act.

Some facts accepted by the Assembly: modern medical research has found beneficial uses for marijuana (which apart from relieving nausea also relieves neurological pain unrelieved by other prescription narcotics).  99 of 100 arrests for marijuana are done under state law, even though the states are NOT required to follow the federal government on enforcement (review states’ rights -it’s a big and old topic).

So how will it work? Much like Cali, there will be a prescribing physician who certifies the permit.  It will be available for: seizure disorder, intractable skeletal muscle spasticity (like MS) and glaucoma.  Plus the following:  chronic pain; wasting syndrome (that’s almost redundant) from HIV, any other immune deficiency syndrome and cancer.   Plus the following:  MS; IBS (wait, what?) including Chron’s; terminal illnesses; and, any other approved condition (a player to be named later).

Like everything else the government tracks, there will be a registry. To prescribe, physicians must be on it.  It’s anyone’s guess who has access to it.  Application fees are based upon a sliding scale (the rich payor provision).  Oh there’s more.  You will be fingerprinted with the State Police and FBI (don’t complain, lawywers are required to do this to sit for the bar exam) following a background check, which requires your consent (of course if you don’t consent, no card).

For the end stoner (I mean user) the Department will keep a confidential list of all of you (wink, wink).

Oh and you are specifically prohibited from doing the following while receiving your medical treatment:  operating, navigating or controlling a vehicle, aircraft, railroad car, stationary heavy equipment (not moving?!) or vessel.  And you can’t smoke on the school bus or in your car (if the engine is on) at the beach or in a park where other smoking is prohibited.  Or in a correctional facility.  (Yes your NJ tax dollars will be funding cards for inmates too).

The doctor will set the amount, in weight –not to exceed two (2) ounces per month dispensed at one time.  Multiple prescriptions are authorized up to 90 days.   And you can only register to receive at one (1) center at a time.  Every two years, the commissioner (You knew there would be more government jobs created) will review the number of centers operating and evaluate whether too much (or presumably too little) marijuana is being dispensed to the masses.

One to follow. (Provided your short term memory permits). One to follow.

~Posted by D.M. Schwadron, Esquire

San Bernardino, California (January 9, 2010) – Rudolph Foods is recalling 39 cases of Pepe’s Louisiana Hot Gigante Cracklins, 3,537 cases of 7-Select Louisiana Hot Onion Rings and 420 cases of Rudolph’s Louisiana Hot OnYums, because it may contain undeclared milk. People who have an allergy or severe sensitivity to [...]]]> Source: U.S. Food & Drug Administration

San Bernardino, California (January 9, 2010) – Rudolph Foods is recalling 39 cases of Pepe’s Louisiana Hot Gigante Cracklins, 3,537 cases of 7-Select Louisiana Hot Onion Rings and 420 cases of Rudolph’s Louisiana Hot OnYums, because it may contain undeclared milk. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products. (Personally, I like a nice glass of milk with my Hot Cracklins, but then I don’t have lactose “issues.”)

Pepe’s Louisiana Hot Gigante Cracklins were distributed in Southern California. Rudolph’s Louisiana Hot OnYums and 7-Select Louisiana Hot Onion Rings were distributed in California, Nevada, Oregon, Arizona and Washington State. (Oddly none are actually distributed in product namesake, Louisiana…)

The products being recalled are the 3.5 oz. Pepe’s Louisiana Hot Gigante Cracklins with UPC # 0-24622-51131-7 and code date March 19, 2010; 1 5/8 oz. 7-Select Louisiana Hot Onion Rings with UPC # 0-52548-05785-5 and code dates February 26, 2010 through April 30, 2010; and 8 oz. Rudolph’s Louisiana Hot OnYums with UPC # 0-24622-57079-6 and code dates February 5, 2010 and March 12, 2010. Please reference 4-digit manufacturing codes that include an “s”, located beneath the sell by date, for affected products.

No illnesses have been reported to date in connection with this problem.  The recall was initiated after it was discovered that the manufacturer inadvertently placed the wrong packaging on these products that did not reflect the presence of the milk ingredient.

Consumers who have purchased any of the above are urged to return them to the place of purchase for a full refund.  (Really? Just throw them out. How much could Craklins cost?) Consumers with questions may contact Todd Zwiebel, Corporate Quality Assurance Manager, Rudolph Foods at 800-342-7546 ext.112.

~Posted by D.M. Schwadron, Esquire

Shangdong (no, I’m not making that up) Province China.  Li Jingchao (aren’t you happy we have child privacy laws now haters?) a 14 month old toddler is in recovery at Bo Ai Hospital Beijing.  Swine flu? MRSA? No, chopsticks. Wait…what?!

Little Li was apparently “playing” with the chopsticks when he somehow fell onto [...]]]> Source: AP News; Stuff.co.nz

Shangdong (no, I’m not making that up) Province China.  Li Jingchao (aren’t you happy we have child privacy laws now haters?) a 14 month old toddler is in recovery at Bo Ai Hospital Beijing.  Swine flu? MRSA? No, chopsticks. Wait…what?!

Little Li was apparently “playing” with the chopsticks when he somehow fell onto one of them, lodging it 4 mm (about a foot for the metrically challenged -Like they’ll know) into his brain through his nostril.  Mom, was washing dishes at the time.  Due to inadequacies of the local hospital (welcome national health care) the family traveled over 10 hours by car for the removal procedure.  He’s said to be resting comfortably with only slight bleeding and an infection. Yeah, I’ve nothing else to say.

~Posted by D.M. Schwadron, Esquire.