Cosmetic surgery laws often aren't enough

Early last year, Irma Carabajal LeCroy was a successful Dallas real estate broker who owned two homes, a luxury car, an SUV and a small office building. Today, she is out of work, uses a walker and wheelchair to get around and says she has nothing left to her name.

And it's because of what she thought was a minor cosmetic surgery procedure.

LeCroy is one of a growing number of women who have had liposuction, sometimes combined with fat-transfer surgery, in doctors' offices or med spas — salon-like medical facilities that have doctors on the premises and offer skin care treatments, such as Botox injections, facials and laser resurfacing.

Some patients have found themselves disfigured or disabled. Others have died. Critics say the victims may not know that the rules that govern hospitals do not necessarily apply to the medical offices or spas popping up across the country. That's where a new breed of cosmetic surgeon now practices, often down the hall from where they do routine physicals, perform gynecological exams or pull wisdom teeth, according to state regulators, lawyers and plastic surgeons.

USA TODAY reported last year that only half of states require licensing or accreditation of medical offices where surgery is performed. But even when there are office-based surgery rules or laws in place, they often aren't enough, critics say. For example, most accreditation or licensing rules cover surgeries only if the patient is fully anesthetized. Some rules apply only if private insurance or Medicare is billed, which typically isn't the case in cosmetic procedures.

There are now about 4,500 med spas in the United States, up from about 800 five years ago, says Allan Share, executive director of the International Medical Spa Association. The growth of med spas has states scrambling to figure out how much legal oversight is needed. The Federation of State Medical Boards recently hosted a workshop for medical board attorneys that covered the regulatory oversight of med spas and office-based cosmetic surgery.

State medical boards and the laws regulating the practice of medicine were "created 100 years ago when cosmetic procedures or surgeries weren't anything that anyone had contemplated," says Mari Robinson, executive director of the Texas Medical Board. "It was about treating illness and disease — not this idea of people personally pursuing medical procedures solely based on improving their appearance."

In September, Maryland's health department shut down the Monarch Medspa in Timonium after three women contracted Group A Streptococcus infections during liposuction and one died. The department cited "deviations from standard infection control practices."

The Group A Streptococci bacteria, which can cause strep throat, are often found in the throat and on the skin and are spread through direct contact with mucus from infected people or contaminated surfaces, according to the health department. Most of these infections are relatively mild, such as with strep throat, but they can cause serious and even life-threatening complications.

Protecting consumers

Joshua Sharfstein, Maryland's secretary of Health and a pediatrician, sent a letter to three committee chairmen in the Maryland legislature last month asking them to tighten laws governing outpatient surgery. The existing law doesn't apply to outpatient surgery centers unless insurance companies are involved, according to a department press release. Health insurance typically covers only medically necessary or reconstructive plastic surgery after cancer. He also asked that the state Board of Physicians database include information on whether doctors perform cosmetic surgery and whether their facility is accredited.

"We asked ourselves if more needs to be done to protect consumers from unsafe cosmetic surgery," says Sharfstein. "There are some protections that exist for bigger surgical centers, but gaps in regulation might put consumers at risk" because smaller operations, including med spas, can take advantage of loopholes.

In Texas, doctors with office-based surgery centers or med spas that aren't accredited by one of three outside entities or licensed as ambulatory surgery centers, can register them for any level of anesthesia used that is above local anesthesia.

It wasn't the anesthesia that harmed LeCroy, however. It was the surgery itself, according to a lawsuit filed on her behalf against internal medicine doctor Hector Molina and the company that sold him the liposuction machine. The suit charges that Sound Surgical Technologies should have known of the risks of a non-surgeon who was not adequately trained in liposuction using the machine. In its response to the suit, Sound Surgical denied the allegations and says it was not to blame for any of LeCroy's injuries. In a statement provided to USA TODAY, the company said LeCroy's attorneys aren't suggesting the liposuction machine was defective, so it "is confident that it will be dismissed from this lawsuit either before or during trial." LeCroy's attorney, Jim Mitchell, says it wasn't that the machine was defective, it was that "Dr. Molina simply didn't know how to use the system."

When they prohibited Molina from performing cosmetic surgery in April, a Texas Medical Board disciplinary panel found his "entire knowledge" of the procedure he performed on LeCroy (who it did not name) "consisted of reading a book provided by the manufacturer of the liposuction equipment, completing an online program over two weeks, passing an online exam and completing one procedure under the direct supervision of another surgeon."

Texas-size problems

LeCroy was left permanently disabled by Molina due to problems including massive infection and the nerve and muscle condition known as "compartment syndrome," which causes body tissue to die, according to her lawsuit and an expert witness report by Miami plastic surgeon Alberto Gallerani. Molina denied the allegations in an answer to the lawsuit, and his lawyer declined to comment.

After LeCroy's more-than-nine-hour liposuction and fat-transfer surgery, Molina and a doctor assisting him abandoned her in his office "without any medical supervision or monitoring," according to Gallerani's report. Her friend, Marilyn Walker, found her "short of breath, unable to stand" and in severe pain in her legs and feet, the report said. She was rushed to the emergency room and transferred to a trauma center. So much fat was injected into the muscles in her buttocks, it caused the compartment syndrome, which Molina failed to diagnose, according to Gallerani's report. LeCroy needed 27 more surgeries to treat the compartment syndrome and related complications, according to Gallerani's statement. She spent a month and a half in the hospital.

LeCroy, 49, now has a home health aide coming to her house three times a week. The money she earned selling real estate, which she did starting at age 25, went to pay medical bills, because complications from cosmetic surgery aren't covered by insurance. She says she is unable to walk without a walker and needs a wheelchair for long distances. "I have nothing," says LeCroy. "I'm down to $698 a month in disability benefits."

Harlan Pollock, a Dallas plastic surgeon and past president of the American Association for Accreditation of Ambulatory Surgery Facilities, says Texas' law doesn't go far enough to protect patients.

When offices register with the state of Texas, certain requirements kick in for the safe administration of anesthesia, according to Texas Medical Board spokeswoman Leigh Hopper. These include the presence of a doctor and another person certified in treating cardiac arrest and a "crash cart" containing life-saving equipment. But Pollock says these requirements apply only to anesthesia and have little to do with the safety of the surgery itself. Accreditation, on the other hand, would require sterile procedures, physical requirements for the operating room, safety equipment and thorough record-keeping procedures, Pollock says. Sterile procedures are key for infection control, which was what Maryland officials found lacking at Monarch Medspa, medical experts say.

This kind of "an out," in Pollock's words, means "The public has no real assurance that the facility is an adequate facility, and that is disturbing and a real concern," he says.

On Nov. 30, the Texas Medical Board barred Molina from ever performing surgery or dispensing controlled substances, a category that includes some pain medications, such as those with codeine. But Texas has done little to crack down on the offices and med spas where doctors like Molina practice cosmetic surgery, say plaintiff attorneys and plastic surgeons.

Hopper emphasizes that Texas' medical board "rigorously screens" doctors who apply for medical licenses. And once they have these licenses, doctors are required to meet what's known as the generally accepted standard of care no matter what area they practice in, she says.

Still, if Texas' state Legislature wanted to address office-based surgery, Robinson says, the board would "be happy" to implement any new rules.

LeCroy isn't the only Texas patient to suffer after cosmetic surgery in a doctor's office or med spa. The Texas Medical Board also found OB/GYN Barbara Marino didn't meet the "standard of care," have emergency procedures in place or maintain a sterile operative facility during liposuction on patients at Medspa 21 in Houston. One died two days after his liposuction, and an autopsy report said the cause of death was "acute toxicity" from the combined effects of four medications, including a patch for the pain medication Fentanyl, according to the medical board's records. Another patient had excessive levels of pain medicine, the board said.

Late last month, Marino was ordered to observe at least 30 hours of cosmetic surgery by a board-certified plastic surgeon and document other procedures for treating at-risk patients and dealing with emergencies. She did not respond to calls seeking comment.

In November 2011, Laura Bennack, an emergency room doctor who owns Radiance MedSpa in San Antonio, had her practice put under the supervision of another physician by the Texas Medical Board. It had investigated the treatment of 10 cosmetic surgery patients and found she didn't meet what it considers the appropriate "standard of care" or keep adequate surgery records. According to the board's disciplinary order, Bennack performs tummy tucks, liposuction and breast augmentation while patients are awake. The board said in an order in February 2010 that Bennack acknowledged her medical record keeping was "sparse at best." Bennack did not respond to calls seeking comment.

Little regulation

Med spas typically offer only procedures without anesthesia or under local anesthesia, which isn't regulated in Texas or many other states. "There is absolutely no regulation of med spas," Pollock says. "That's something that to me is very frightening."

Some doctors, including Marino and Molina, register their facilities for higher levels of anesthesia. Several states require accreditation for offices intending to use deep sedation or general anesthesia, since it is the type used for the most serious procedures, says Tampa anesthesiologist Hector Vila. But doctors can get around the law by registering for a lower level of anesthesia or using large volumes of local anesthesia, says Vila.

Vila says existing laws need to be more strictly enforced to ensure people don't continue to skirt them. Performing surprise inspections and more frequent inspections could be one way to accomplish this, he says.

Some of the toughest laws:

Florida. The state changed its law early this year to authorize the state to inspect any facility, including med spas, that remove more than 1,000 cc's of fat during liposuction. That would cover all but the most minor procedures, says Democratic state Sen. Eleanor Sobel, who introduced the bill. Previously, the inspection authority existed only for facilities that accepted Medicare or other insurance. The law was passed after two women died of an overdose of lidocaine, a local anesthetic similar to novocaine, after liposuction.

California. Under a law passed in January, California's medical board keeps a list of accredited outpatient surgery settings. The board approved four accreditation agencies that inspect and accredit outpatient surgery settings, including medical offices and spas. These agencies can reject, revoke, or otherwise restrict a facility's accreditation. If that happens, the medical board is notified and alerts the public on its website.

New York. Any office-based surgery facility that removes more than 500 cc's of fat during liposuction or uses anything more than minimal sedation must be accredited. Still, even though New York has some of the most stringent regulation of office-based surgery, any licensed physician can perform cosmetic surgery under a local anesthetic in an unaccredited facility, says Manhattan plastic surgeon Adam Schaffner. "My hope is that they will require that physicians who perform such procedures perform them in accredited facilities (and) that they have hospital privileges for any procedure they perform outside the hospital," says Schaffner.

The issue of med-spa regulation is "absolutely rising to a national level ... everyone is really looking at it right now," says Robinson.

"Every single person needs to pay attention to the training of the person who's doing the procedure and the status of the facility — whether it's accredited or not," says Sharfstein. "What you find out can make the difference between life and death."

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Source: US Today (O'Donnell, 12/10)

More DPS workers testing blood to ease backlog

AUSTIN, Texas — The Texas Department of Public Safety has reassigned about 15 crime lab workers to blood testing to help trim a backlog in drunken driving cases.

The Austin American-Statesman and KVUE-TV reported Thursday that the number of blood samples sent to DPS rose 500 percent in six years as police increasingly use such evidence in DWI cases.

DPS increased the number of blood testing analysts by 20 percent by temporarily moving employees from areas without as many samples. Spokesman Tom Vinger says DPS in 2009 added nine blood testing positions but no additional workers in 2011 due to state budget constraints.

Sen. John Whitmire of Houston, who chairs the Senate Criminal Justice Committee, says it's a glaring example of not having enough resources to do the job.

Legislators convene in January.

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Source: Lubbock Avalanche Journal (AP, 12/7)

Seven injured in Texas State bus, SUV collision

Seven people were injured in an accident involving a Texas State University bus and an SUV.

The accident happened around 3 p.m. at 5th Street and Trinity.

Investigators say the bus collided with the SUV and then hit and uprooted a tree.

"The bus driver was out cold unfortunately and he was one of the first people to be pulled off. There was a lot of people who had hit their face on the seat in front of them. So there was some people like I guess bleeding on themselves and things but they were ok," Matt, a Texas State student said.

Six people were taken to UMC Brackenridge, and another person was taken to Saint David's. The driver of the bus was one of the injured.

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Source: My Fox 7 (11/28)

Man accused of driving wrong way on I-20 charged with intoxication manslaughter

A man involved in a fatal car accident Friday was arrested late last week by the Texas Department of Public Safety for intoxication manslaughter, said a spokesman for the agency.

Gustavo Cervantes, 36, of Wichita Falls, was driving a 2002 Dodge Ram eastbound in the westbound passing lane of Interstate 20 at 2:40 a.m. Friday, said Sparky Dean, DPS spokesman. His vehicle collided nine miles west of Sweetwater with a vehicle driven by Cory Lynn Carlile, 41, of Rowlett.

Carlile was pronounced dead at the scene.

Cervantes was taken to Hendrick Medical Center on Friday with "incapacitating injuries" but was released later that day; afterward he was arrested and charged, Dean said.

Cervantes posted a bond of $20,000 and was released from the Nolan County Jail.

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Source: Reporter News (Collins, 11/28)

Deaths at Texas railroad crossings rising, despite state safety plan

DALLAS — Deaths at railroad crossings in Texas have doubled in the last year, renewing questions about whether the thousands of miles of track in the state is being safely maintained and monitored, figures compiled by The Associated Press show.

The spike in fatalities comes after a four-year period in which Texas had lowered its death toll significantly and with the state in the midst of implementing a federally mandated plan aimed at improving rail-crossing safety.

They include not only the Nov. 15 accident in Midland that claimed the lives of four military veterans on a parade float, but an equally horrific accident that killed three generations of one family in the East Texas town of Diboll last March.

Critics of the railroads believe they deserve much of the blame for increasing the speed of trains without adjusting the timing of crossing gates, while state authorities contend that motorists are ultimately responsible for their own safety.

"In 2012, we can do all kinds of exploration in space, and yet, with all that technology, people are still getting killed at railroad crossings," said Sally Tingle, executive director for the Texas chapter of Operation Lifesaver, a nonprofit organization dedicated to eliminating railroad crossing accidents.

The AP found 32 people died this year at railroad crossings in Texas, based on federal data, news accounts and statements from the Texas Department of Transportation. For the previous four years, the state had averaged just 20 deaths a year. That followed two years in which the death toll reached 34 and 44.

The 2012 Texas death toll contrasts with the national statistics, which show railroad crossing deaths have generally decreased in the last five years and could be headed for a further drop-off this year. Data compiled by the Federal Railroad Administration through the end of August shows 168 deaths nationally, 10 less than what was reported for the same period in last year.

Experts said the spike in deaths in Texas merits evaluation, but they cautioned that it may simply be a statistical anomaly. The best measure is what the numbers show over several years, they said.

"Every accident is important, particularly to the family and community that experienced it," said Bob Chipkevich, former director of the National Transportation Safety Board's railroad accident investigation division. "But when you look for trends, you have to look at the longer term."

Texas, with nearly 11,000 miles of track, was one of 10 states required to develop a railroad crossing safety action as a result of a federal law enacted in 2008. The states were selected on the basis of the number of incidents at crossings reported for the previous three years.

The Texas plan, developed by the state's Department of Transportation, lists dozens of strategies, including evaluating crossings with multiple accidents and developing outreach programs to better educate the public and law enforcement.

In an email, TxDOT spokeswoman Veronica Beyer said the plan, which won't be fully implemented until 2014, has already led to crossing upgrades and improved education.

However, she noted that motorists "hold the key" to safety.

"We will continue to work with federal partners and railroad companies to ensure safety devices are working at railroad crossings, but, similar to roadway safety, we need the help from Texas drivers to enhance safety at these crossings as well," Beyer wrote.

Bob Pottroff, a Manhattan, Kan., attorney whose practice focuses on railroad crossing accident cases, said it's misguided to put the onus on motorists. The real issue is how the railroads are increasing the speeds of their trains without adjusting mechanical devices at crossings to provide longer intervals between initial warnings and the trains' arrival, he said.

Pottroff, who has filed a lawsuit on behalf of two veterans injured in the Midland accident, said the problem is particularly acute in Texas, a key corridor for moving freight to and from the West Coast.

"They are flying trains through Texas faster than they ever have," he said.

The four veterans killed in Midland were part of a parade honoring wounded vets when the flatbed truck carrying them collided with a Union Pacific train traveling 62 mph. The driver of the truck ventured onto the track after the warning signals had begun to flash and before the arms had descended, according to the National Transportation Safety Board.

The NTSB said the device was activated within 20 seconds of the train's arrival, the minimum standard required by federal regulations. However, TxDOT documents made public last week indicate that the device was designed to activate at 30 seconds.

Darin Kosmak, director of TxDOT's rail-highway section, wrote in an email that trains are traveling along the rail line at a maximum speed of 70 mph even though the crossing's design was based on speeds of no more than 25 mph.

The Diboll collision also involved a Union Pacific train and a crossing set for a 20-second warning time.

The train slammed into a Jeep Wrangler that had stopped on the track soon after the arms descended, causing the deaths of the 19-year-old driver, her 54-year-old grandmother and her 18-month-old nephew.

The conductor told police he thought it was a suicide because the vehicle never moved even though it was on the track for 10 seconds. But Jerry Easley, a lawyer who represented the family in a lawsuit against Union Pacific that was settled out of court, said evidence suggests the vehicle stalled and that the two women struggled to remove the toddler from a car seat.

Easley said video showed the vehicle entered the crossing 26 seconds before impact, but that wasn't enough time to escape the approaching train, which was traveling about 50 mph. The train's operators sounded the horn and backed off the throttle but didn't use the emergency brake until only a few seconds before the crash, he said.

Had the brake been set earlier, the women might have been able to save themselves and the child, Easley said.

"It certainly would have bought them more time, but the railroad can say, 'We don't put on the emergency brake because that might cause a derailment,'" he said.

Union Pacific spokeswoman Raquel Espinoza-Williams said the engineer complied with federal regulations by sounding the horn 21 seconds before the train reached the crossing.

"It is important to remember that trains cannot stop quickly," she wrote in an email to the AP, adding that a train going 55 mph can travel more than a mile before coming to a complete stop.

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Source: Dallas News (AP, 12/01)

After Dozens of Deaths, Inquiry Into Bed Rails

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband, Dan, 80 years old at the time, felt he could no longer care for her alone.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

Instead, in 2006, the F.D.A. issued voluntary guidelines, instructing hospitals and nursing homes on the use of bed rails. They recommended size limits for the gaps and openings in the rails and identified body parts most at risk for getting stuck.

Lara L. Mahoney, a spokeswoman for Invacare, a manufacturer of medical beds and rails in Elyria, Ohio, said newer hospital beds with side rails and stand-alone bed rails are better designed today and come with features like safety straps to prevent patients from sliding between parallel bars.

“The guidance has certainly had an impact on the industry,” she said.

In an interview, Mr. Kessler, the former F.D.A. medical device official who is now a professor at the University of Washington School of Public Health, acknowledged that the manufacturers’ resistance was a factor in not pursuing mandatory rules for bed rails.

But Mr. Kessler said a bigger factor in the F.D.A.’s decision was Congress.

“You have to remember that a few years before we began working on this issue, they had passed legislation telling us to ease the regulatory burden on companies,” Mr. Kessler said. “It would have been impossible to get a set of regulations through in that environment.”

One issue is that hundreds of stand-alone bed rail devices and beds for home use offered at medical supply stores or discount retailers may or may not be considered medical devices, depending on whether the manufacturer makes specific claims, saying, for example, the device will keep a dementia or Alzheimer’s patient from falling out of bed. Without such claims, it may be viewed as a consumer product, the F.D.A. said.

The F.D.A. said consumer safety devices were regulated by the Consumer Product Safety Commission, but the commission has long maintained that bed rails are medical devices and outside its mandate.

But that may be changing. Recently, the agency said it had begun reviewing death and injuries attributed to bed rails and will consider what actions it should take after the study is complete possibly by the end of this month. The commission said it was also coordinating with the F.D.A. to find a way to close the regulatory gap between the two agencies.

“As the elderly population increases we’re going to see more and more people cared for in their homes and assisted living facilities,” said Robert S. Adler, a commissioner with the consumer safety agency, who has made elderly safety a priority at the agency. “Bed rails are widely used in both of these settings and it’s something we need to get a handle on.”

Industry officials say despite the deaths and injuries reported from the use of bed rails, the devices can be an effective way of keeping frail older patients safe. The problem, they say, is when the bed parts — such as the mattress, rails and frame — come from different manufactures.

“This is when you get dangerous gaps in the assembly of the bed which allows a person to slip out between the mattress and rails and get injured,” said Lance Lockwood, an industry consultant and former employee of Hill-Rom in Batesville, Ind., a medical device company that makes hospital beds and bed rails. “This is something that should be explained to nursing homes and family members before they go out and buy these devices.”

In court filings, Ms. Black, whose mother died in a bed rail accident, claimed the staff at the Waterford home suggested the family buy a bed rail to keep her mother from rolling out of bed after she had been injured in a fall, and that no one warned her father when he bought bed rails for her mother. Washington state nursing home regulators said the nursing facility also never told Ms. Black and her father about the dangers of bed rails. Waterford did not respond to requests for comment.

Mr. Adler, the commissioner at the safety agency, credits Ms. Black’s advocacy with prompting the study of bed rail deaths and injuries, a point she plays down.

“Families need to be told about the possible dangers of bed rails,” said Ms. Black, who has since documented hundreds of deaths associated with the devices. “Dangerous bed rails with poor design should not be allowed to stay on the market.”

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Source: The New York Times (Nixon, 11/25)

UPDATE: Texas highway with nation's fastest speed limit records first fatal crash

Mustang Ridge, Texas  - On Sunday afternoon, the driver of a Honda Civic died after a crash with a Chevy Tahoe in the south bound lanes of State Highway 130.

Mustang Ridge Police tell KXAN the accident happened in the newly opened section of SH130 Toll, where the speed limit is 85 mph.

Police are still investigating the cause of the accident and did not say how fast the cars were traveling. But they did confirm that wild hogs were not a factor in the crash. Four accidents involved wild hogs the first night the toll road opened.

The driver and the passenger of the Tahoe suffered minor injuries. The driver in the Civic, Martha Harris, 60, from Lockhart died at the scene.

Police said the accident happened when one of the vehicle's was coming onto the on-ramp at Old Lockhart Road when the two vehicles collided.

The 41 mile toll road opened Oct. 24. The road has the highest posted speed limit in the U.S. at 85 mph.

Today was the first day drivers paid tolls on the road. Prior the road had been free to drivers wanting to try out the new road.

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Source: KXAN (Roberts, 11/12)