England's NHS Saves Lives with World Leading "Dead" Heart Transplants

More than 3,000 heart transplants were performed in the United States last year, according to the federal Organ Procurement Transportation Network (OPTN). These 3,000-plus patients were given the gift of life through the selfless act of organ donation by individuals and families who were faced with the opportunity to make a positive impact in the wake of tragedy. 

This number is truly amazing; the first successful heart transplant was performed  a little more than 50 years ago. Since then, heart transplantation has become more routine,  almost considered as routine as a bypass surgery. With advances in transplant technology, more people are seeking heart transplantation.  Tragically, there simply are not enough donor hearts to go around.  

There are currently nearly 4,000 people across the U.S. awaiting donor hearts, according to OPTN data. Unfortunately, a significant number of patients die before suitable donor hearts become available for transplantation. To meet this ever-growing need, the medical community seeks new and advanced procedures and treatments for heart failure while educating healthy community members how truly life-changing the gift of organ donation is for recipients, donors, and their families.

Finding a healthy living heart suitable and available for donation is difficult.  What if, however, hearts that had stopped could be used in donation.  What was once though impossible or unlikely may someday be routine, thanks to the doctors in England's National Health Service (NHS).

Anna Hadley, a 16-year-old from Worcester, waited for nearly two years for a new heart. Now, almost two years later, Anna is healthy and playing hockey again. Anna has British surgeons to thank, as they "carried out the world's first transplants in children using dead hearts that were brought back to life." 

The surgeons used a pioneering machine to reanimate hearts from donors whose hearts stopped. So far, use of the machine has saved the lives of six British children ranging in age form 12 to 16. Each of the transplants occurred during the pandemic. 

Anna was the first to have her life saved by the pioneering machine. She received the call at 2:30am after she had waited almost two years after being diagnosed with restrictive cardiomyopathy. 

Within 24 hours of the operation, Anna was sitting up in bed. Within weeks, Anna was playing hockey again. Anna said, "I just feel normal again. There's nothing I cannot do now."

Source: Andrew Gregory, NHS saves children’s lives with world-first ‘dead’ heart transplants, The Sunday Times (U.K.), February 20, 2021. 

One Man's Effort to Recover $280 Million in Bitcoin He Accidentally Threw Away

Another object lesson regarding the risks of crypto-currency investing comes by way of James Howells, a 35-year-old IT engineer from Wales.  Howells accidentally threw out a hard drive on which he had stored 7,500 bitcoins.  Although reports did not indicate his initial investment, assuming he purchased the bitcoin in April, of 2011, his initial investment was $7500.00.  The bitcoins are worth about $280 million at today's prices (in April of 2011, the price of a bitcoin skyrocketed to $32 a coin).  

Howells said he had two identical laptop hard drives and he accidentally threw the drive with the cryptographic "private key" that he needed to access his coins in the trash. 

Howells is reportedly confident that he would be able to retrieve the key and recover the bitcoin. If the platter inside the hard drove is still intact, data recovery experts could rebuild the drive and read the data from the platter. The drive, which he threw away eight years ago, is the only way to regain access to the coins. 

Unfortunately, retrieving the hard drive would not be an easy task. Howells will first need to gain permission from local council to search the garbage dump since the landfill is not open to the public. After that, Howells would have to dig through eight years worth of garbage. 

Howells has offered to donate 25% (around $70.8 million) of the bitcoin to a Covid Relief Fund for his city if he is able to find the drive. Unfortunately, city council has rejected his requests so far and they are showing no signs of letting up any time soon. 

For more information, including information on how you might avoid these risks, see the following prior blog posts:

The Strange Case of Crypto Exchange QuadrigaCX: Death and a Missing $200 Million

LegalVault® Offers Solution to Estate Planning Challenges of Bitcoin and Cryptocurrencies 

Source: Man makes last-ditch effort to recover $280 million in bitcoin he accidentally threw out, CNBC News, January 15, 2021.

Winner of $188M Powerball Sued By Her Ex-fiance Inmate

I advise lottery players to consider the implications of winning, and strongly recommend that they retain legal and tax counsel BEFORE collecting winnings.  In some states, it is possible to collect lottery winnings through a trust, keeping the actual winner's name confidential from family, friends, and those who are neither.  

An object lesson why such planning is important comes in the case of Marie Holmes, the winner  of the $188 million Powerball jackpot in 2015, which was the largest jackpot winnings in North Carolina history. After taxes, the winnings amounted to $87.9 million. 

Ms. Holmes was certainly a person blessed by the winnings; she was working five jobs when she won.  She stated that she planned to give a portion of her winnings to charities and religious organizations, and to use some of the money to go back to college and buy her mother a house. 

Holmes' ex-fiance, Lamarr Andre McDow, claims that Holmes spent money on generous and lavish gifts for him. McDow alleges that Holmes has given away or sold these gifts after they split up and now he is suing to get them back. 

McDow claims that Holmes breached her fiduciary duty "when she reportedly gave away his 77-acre dirt bike track, his car repair shop and tens of thousands of dollars worth of clothing and jewelry while he was in prison." 

Holmes' defense attorney stated in a motion to dismiss, “This case is the embodiment of the phrase ‘[w]hat’s yours is mine and what’s mine is my own.’ The problem here, however, is that McDow has nothing of his own.”

McDow was convicted of drug trafficking in April 2016 and was sentenced to 10 years in prison. He is projected to be released in June 2023. 

McDow made Holmes his power of attorney before he went to prison. 

Apparently, McDow heard that Holmes began dating someone else after their split, and began giving away McDow's things. According to McDow's attorney, “Ms. Holmes’ unconditional obligation to act in the best interests of Mr. McDow didn’t stop because Ms. Holmes and Mr. McDow’s relationship ended.” 

As of now, McDow has not responded to the motion to dismiss. 

It seems likely that McDow would not have filed any lawsuit against his ex-fiancée, a person then-working five jobs to make ends meet, but for her good fortune.  No one knows for sure, but one wonders whether a little planning would have avoided the dispute.  Worse, each time Ms. Holmes is "in the news" regarding her winnings, more people people become aware of her good fortune, and might resolve to insinuate themselves in her life in order to realize benefit.  Planning might have avoided these challenges.  

Source: She won $188M Powerball. Now her ex-fiance is suing her from prison, NC lawsuit says, Yahoo News, February 21, 2021.

Infection Control Citations Exceed 12,000 Amid Pandemic; SNF Ratings Stagnant

Despite more than 12,000 infection control-related citations issued during the COVID-19 pandemic, most U.S. nursing homes saw no  ratings change in updated Five-Star guidance published recently, according to an article in McKnight's Long-term Care News.

According to McKnight's, Formation Healthcare Group found in analyzing the data that the prevalence of citations has not changed drastically during the pandemic, with the average health tags cited per facility dropping to 8.1 from a prior average of 8.2.  

Among more than 22,000 citations issued, more than 12,000 were related to infection control, a factor the Centers for Medicare & Medicaid Services (CMS) initially said would not affect star ratings used by the public. The agency reversed course in December.  Many were critical of the reversal, even as the new ratings were published.

Jessica Curtis, Formation’s managing partner, explained to McKnight's that infection control citations are being driven by the mandated infection control-focused surveys during the pandemic. A group of six frequent F-tags accounted for more than 8,000 citations.

Despite the inclusion of infection measures in the star calculation, nearly 12,000 facilities saw no change in their health inspection ranking, according to an analysis by Steven Littlehale, Chief Innovation Officer at Zimmet Healthcare Services Group. .

About 2,800 gained one star or more for improved RN staffing ratings, while fewer than 2,400 saw that factor drop one star or more. Nationally, staffing levels were higher in January 2021 than they were in January 2019 and 2020.  In 2019, one-third of institutions saw a rating drop specifically due to staffing levels, thanks in part to a new survey method preventing institutions from misrepresenting their level of staffing.  In all other categories, the number of institutions gaining a star or more was essentially the same as the number losing one or more.

Overall, 9,937 facilities, or about 66% nationwide, kept the same overall star rating.  

“From a macro view, this is a lot to do about nothing,” Littlehale told McKnight’s Long-Term Care News. “If you’re the provider holding the bag, being dropped from a preferred provider network, triggering loan covenants or consternation from a family member, it means something.” 

He noted that the update includes two quarters worth of COVID-impacted outcomes. He suspects a “national dip” is more likely once all of the 2020 MDS-based outcomes are calculated.

As for the “abuse” icon adopted by CMS in 2019, 459 facilities will see the icon disappear from their listing based on the latest numbers, while 262 facilities will get one.  That doesn't suggest that the incidence of reported abuse has declined, however, just that the number of facilities with a reportable incidence of abuse has declined.   Moreover, while the rating system is helpful in comparing institutions, the rating system does not accurately reflect resident safety.   

The latest star ratings also reveal major variations in how and how well states are performing their inspection duties.  “The percentage of facilities receiving deficiencies during infection control surveys vary considerably across the states,” Littlehale said. “Some states see over 60% of their facilities with IC deficiencies, while other states (are) as low as 6%.”

Littlehale told McKnight's  that the wide variation was not directly attributable to COVID outbreaks.

Analysts at Formation Healthcare likewise found discrepancies between states in reporting. Shockingly,  several states are far behind in conducting health inspections. For example, Oregon (37%), Georgia (31%), Maryland (26%) and Virginia (21%) led the nation in the share of SNFs last inspected more than two years ago.   In other words, in some states, the data on nursing homes may be inaccurate or outdated for almost one-third of the state's institutions. 

The pandemic, governments' response to the pandemic, and institutional safety and quality are only making more arguments for the already overwhelming case for aging in place.  Plan now. 

AARP Nursing Home COVID-19 Dashboard

The COVID-19 pandemic has swept the nation, killing more than 160,000 residents and staff of nursing homes and other long-term care facilities. The AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner. The dashboard looks at five categories of impact and will be updated every month to track trends over time. 

In addition, the dashboard site provides a link to state and national fact sheets with 33 additional data points providing more information about each dashboard category.  

This February 2021 dashboard release (with data for the four weeks ending January 17, 2021) shows how the COVID-19 situation in nursing homes has changed dramatically since the summer when data became available:

Among the most concerning data is that relating to staffing shortages.  Staffing shortages continue to be an ongoing problem throughout the pandemic, with 29% of nursing homes reporting a shortage of nurses or aides in the last 4 weeks.  Going back to June 2020, in every four-week period, more than one quarter of nursing homes have reported a shortage of direct care staff.  

The rates of COVID-19 deaths and cases in nursing homes remain staggeringly high as we enter the new year.  The resident death rate reached a new high, increasing from 1.88 per 100 residents in the previous four-week period to 1.95 per 100 residents in the four weeks ending January 17. 

New resident cases declined slightly from 10.8 to 9.2 per 100 residents, and new staff cases also declined from 9.3 to 8.3 per 100 residents.  These most recent case rates are still more than 3 times as high as the rates in late summer and early fall when AARP launched the dashboard, and only slightly lower than the record high numbers the previous month.

Counting both residents and staff, there were nearly 20,000 COVID-19 deaths and more than 170,000 new confirmed COVID-19 cases in nursing homes in the four weeks ending January 17.

There is considerable variation across states in both the magnitude of COVID-19 impacts, and the trajectory of those impacts.

Compared to the previous four weeks ending December 20, the resident death rate per 100 residents increased in 24 states (including Washington DC), and declined in 27 states.

Compared to the four weeks ending December 20, the rates of new resident cases and new staff cases each declined in two-thirds of states (34 states) and increased in the remaining third (17 states, including Washington DC). 

In every state, nursing homes continue to indicate a shortage of PPE (defined as not having a one-week supply of N95 masks, surgical masks, gowns, gloves, and eye protection during the last four weeks). Nationally, about 14% of nursing homes had a PPE shortage during the four weeks ending January 17, 2021.  This is a significant improvement from 18% in the previous monthly Dashboard and 28% in the summer.  Still, this means that about 1 in 7 nursing homes do not have a one-week supply of PPE during a time when deaths and are close to record highs. There is considerable variation in PPE supply among states: the proportion of nursing homes without a one-week supply of PPE ranged from less than 2% to as high as 42%.