Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

Tennessee authorities are now investigating what appears to be tell-tale signs of nursing home abuse following the hospitalization of a 100-year-old woman.  After the centenarian was admitted to the hospital with severe hemorrhaging, broken ribs and pressure sores, the hospital contacted the local police department as well as the Tennessee Adult Protective Services.

Prior to her hospitalization, the woman was a patient at Boulevard Terrace Nursing Home for treatment related to a fractured femur she sustained prior to her admission.

As authorities look into this patient's suspicious injuries, the woman's family has relocated her to another facility.

Most states have laws that require health care workers who are in contact with children or the elderly to report suspicious injuries to law enforcement agencies immediately for further investigation.  I have seen many cases of suspected mistreatment that get timely reported actually get verified through the diligent efforts of law enforcement.

In addition to determining the perpetrators, investigations completed by police, health departments and other applicable agencies has proved especially helpful in prosecuting nursing home abuse and neglect cases from a civil standpoint.  Many of these initial investigations prove crucial in the successful resolution of claims and lawsuits.  As a result, I encourage all families who suspect improper care to report the situation to authorities as soon as feasible to begin the investigative process.

Related:

MPD probes elder's injuries, The Daily News Journal, August 18, 2010

Medical Examiner Rules Tennessee Nursing Home Death A Homicide

Most Nursing Home Deaths Remain Un-investigated

Elder Abuse Is Widespread, Yet Only 4% of All Cases Get Reported To Authorities

• Email This
• Print
• Comments
• Trackbacks

In a previous post, I talked about Reglan (Metoclopramide), a drug commonly used to relieve heartburn in patients with GERD (gastroesophageal reflux disease) or to relieve symptoms of slow stomach emptying for people with diabetes. Well, it turns out that this drug can also cause tardive dyskinesia (TD). Tardive dyskinesia is abnormal muscle movements, mostly in the face muscles, that you have no control over. TD has no treatment, and the symptoms might not go away even you stop taking raglan. 

Clearly, TD is not a minor side effect. The FDA took action requiring manufacturers of the drug to add a “black box” warning about the drug’s risks. The U.S. National Library of Medicine – National Institute of Health Website now includes an IMPORTANT WARNING in its information for metoclopramide (better known as Reglan) –

“Taking metoclopramide may cause you to develop a muscle problem called tardive dyskinesia. If you develop tardive dyskinesia, you will move your muscles, especially the muscles in your face in unusual ways. You will not be able to control or stop these movements. Tardive dyskinesia may not go away even after you stop taking metoclopramide. The longer you take metoclopramide, the greater the risk that you will develop tardive dyskinesia. Therefore, your doctor will probably tell you not to take metoclopramide for longer than 12 weeks. The risk that you will develop tardive dyskinesia is also greater if you are taking medications for mental illness, if you have diabetes, or if you are elderly, especially if you are a woman. Call your doctor immediately if you develop any uncontrollable body movements, especially lip smacking, mouth puckering, chewing, frowning, scowling, sticking out your tongue, blinking, eye movements, or shaking arms or legs.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with metoclopramide and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website(http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Talk to your doctor about the risks of taking metoclopramide.”

The FDA’s medication guide also includes warnings about how Reglan can cause tardive dyskinesia. TD (as a result of Reglan) is most common in the elderly, especially elderly women.  

Reglan Drug Timeline

• June 1985 – FDA approved metoclopramide – FDA approved metoclopramide for short-term use (less than 12 weeks). 
• February 26, 2009 – FDA Press Release – “FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs – Agency warns against chronic use of these products to treat gastrointestinal disorders”
• March 2009 – FDA’s MedWatch Safety Alerts, March 2009 – FDA alert discussing boxed warning. Also, manufacturers must ensure that patients receive a medication guide with the drug risks each time they receive the medication from a pharmacy.

Prescribing Reglan

At the time of the FDA’s decision to require a black box warning, more than 2 million Americans were taking metoclopramide drugs. Reglan was commonly prescribed for patients suffering from acid reflux, GERD (gastroesophageal disorders), and nausea. According to the FDA, metoclopramide is only recommended for short-term treatment (≤ 3 months) of gastrointestinal disorders. 

However, many patients have taken Reglan for longer periods of time, increasing their risk of TD. In many cases, Reglan was a treatment option that offered positive results in treating gastroesophageal problems, but it came with a serious risk. Reglan now carries a warning against frequent and long-term use, but this warning came too late for many people who now suffer from lasting side effects such as tardive dyskinesia. Older people, especially older women, and people who have been taking Reglan for a long time are most at risk for tardive dyskinesia. 

Metoclopramide was even prescribed to women suffering from morning sickness. In a June 2009 article, MSNBC reported about a study in the New England Journal of Medicine that showed that metoclopramide could be prescribed to pregnant women suffering from morning sickness in the first trimester without causing harm to their babies. The drug was prescribed to pregnant women for short-term use and most women in the study only took the drug for 7 days. 

Morning sickness is most common in the first trimester, but it can last throughout pregnancy for some women. Because morning sickness can last longer than the 12-week maximum that the FDA recommends in order to reduce the risk of TD, it seems misleading and inappropriate that the reports would not at least mention the FDA black box warning. The risks associated with long-term use of a drug should be discussed, or at least mentioned, when discussing a new use of a drug, especially to inform potential users of all possible risks. 

Status of Reglan Litigation

Reglan has been prescribed to numerous patients since it was approved in 1985. And, according to the FDA, over 2 million Americans use metoclopramide. According to the drug makers, there have been over 20 years of Reglan litigation. 

On June 3, 2009, the U.S. Judicial Panel on Multidistrict Litigation denied the plaintiffs request to consolidate the Reglan litigation during pretrial proceedings in a Multidistrict Litigation (MDL). This motion was filed by plaintiffs in 15 different Reglan lawsuits in 11 different district courts. The drug makers opposed the consolidation, citing that since the first Reglan case was filed in 1988, there have been more than 20 years of Reglan litigation, and 80% of those cases were resolved. 

The Panel determined that there was no single common defendant and most questions that remained were too complex or numerous to support consolidation, despite the cases involving the common factual issue about whether Reglan causes tardive dyskinesia. 

In one of the Reglan cases, a woman from Arkansas alleges that she developed TD after taking Reglan for over a year. Her case alleges that she did not have access to the FDA’s warnings. The lawsuit states that almost one-third of all patients taking Reglan took the drug for at least a year, increasing their risk for TD. These patients trusted their doctors to make informed and safe decisions about their medical treatment, and they also trusted the drug companies to test the drugs and provide information to patients so they could make informed decisions. Some of the lawsuits claim that the drug makers knew about the risk of tardive dyskinesia for decades. Unfortunately in the case of Reglan, the system seems to have let people down. 

If you believe that you or a loved one suffered an injury after taking Reglan, we would honor the opportunity to speak with you.  In certain situations, a lawsuit may be pursued against the drug manufacturer and the physician who was prescribing it at the time.  As will all of our cases, we prosecute drug-related claims on a contingency basis-- clients never pay any expenses out of their pocket.  (888) 424-5757.

Thank you to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog entry.

Sources:

Nursing Homes Abuse Blog: Use of Reglan Has Been Linked to Development of Tardive Dyskinesia or Abnormal Muscle Spasms

Medicine Net: Metoclopramide

FDA’s MedWatch Safety Alerts, March 2009: Reglan and Nervous System Disorder

About Lawsuits: Reglan Litigation Will Not Be Consolidated in MDL

eMedicine: Tardive Dyskinesia

National Institute of Neurological Disorders and Stroke: NINDS Tardive Dyskinesia Information Page

The Public Record: More Warnings Needed on Reglan Side Effects

Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesia

The New England Journal of Medicine: The Safety of Metoclopramide Use in the First Trimester of Pregnancy

The New York Times: Drug Appears Safe for Morning Sickness

• Email This
• Print
• Comments
• Trackbacks

I'm always amazed at how shortcuts taken by nursing home staff can result in horrific patient injury or death. Frequently, I see the shortcuts taken by staff as a reflection the facilities failure to train their staff and the facilities decision to cut staffing levels to a bare-bones minimum.

Perhaps the area where I most frequently see staff short-cuts resulting in patient injury occurs during patient transfers.   By law, nursing home patients need to be evaluated if they require assistance for transfers from their beds to wheelchair and vice versa.  

Patient evaluations are conducted to evaluate the level of assistance that are necessary for transfers, and will set forth the necessary requirements based on their mobility level and size.  Patients with little or no muscle control or those patients who are heavier may require the assistance of one, two or sometimes three staff members to perform safe transfers.

I was disturbed (and apparently the jury hearing the case was as well), when I heard of a recent nursing home negligence trial involving a man who was transferred from his bed to a chair without proper staff assistance.  

The incident occurred at Brockton Embassy Rehabilitation and Health Center in Massachusetts, when a nurses assistant (CNA) attempted to move the elderly man from his bed to a chair with the use of a Hoyer lift-- a device that helps lift and move patients from one area to another. When the CNA attempted to move the man-- by herself-- a piece of the lift struck the man in the eye.  The eye injury was so severe that the man's entire eye had to be removed in a surgery at Tuft's Medical Center.

An investigation into the incident determined that the man was to be transferred via a two-person lift-- as opposed to a single nurse attempting to do so.  As a result of the nurse's lapse in judgment, she was fired and the state suspended her nursing license for six months.

Apparently, the jury thought the CNA's judgment lapse in terms of failing to get another staff member to assist-- was egregious that they awarded the man's family $400,000 despite the fact that the patient died 47 days after the initial injury-- from unrelated causes.

My take:

In situations such as this, I tend to put a substantial responsibility on the part of the facility itself-- as opposed to the individual employee.  Too frequently, I see facilities that over-work their employees to the point where it simply isn't feasible for staff to request additional assistance without drastically impeding the daily operation of the facility.  Is under-staffing to blame for many occurrences such as the above?  You bet!

Related Nursing Homes Abuse Blog Entries:

Safe Transfers

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Faulty Handicapped Lift Blamed For Nursing Home Death

• Email This
• Print
• Comments
• Trackbacks

On November 24, 2009 nursing home surveyors from the Illinois Department of Health (IDPH) conducted an inspection of Edwardsville Terrace, a nursing home in Edwardsville, IL.  The inspection of the facility found numerous violations of federal and state laws applicable to nursing home care.

In particular, surveyors discovered the following alarming situations at the Southern Illinois facility:

• The facility failed to have written procedures regarding patient care (Section 350.620 Resident Care Policies)
• Edwardsville failed to provide skilled nursing services that are required to maintain each patient's health-- when the facility failed to identify signs of physical and psychological illness that were apparent in one of the patients (Section 350.1210 Health Services)
• Delaying the implementation of medical care that was necessary for patients who need the services of a physician, licensed nurse or professional nurse
• Failed to maintain adequate patient records pursuant to Section 350,1610
• Neglecting a patient in violation of Section 2-107 of Illinois' Nursing Home Care Act

The above violations came to light following an investigation of an extremely sick patient suffering from uncontrolled diabetes and severe mental illness amongst other maladies.

Nursing home surveyors focused on the fact that the patient at issue was admitted to a hospital emergency room after an extended illness Edwardsville Terrace.  The unidentified patient was admitted to the emergency room with the following diagnosis:

1. Septic shock
2. Dehydration
3. Cardiomyopathy
4. E. Coil
5. Sepsis
6. Right nephrolithiasis causing E. Coli sepsis
7. Chronic ear infection
8. Hypertriglycerdemia

The nursing home patients acute illness necessitated extensive medical treatment and extended hospitalization. While reviewing the patient's chart from Edwardsville Terrace, a gross lack of documentation lead the surveyors to believe the facility failed to provide essential medical care.

Certainly, this survey should give patients and their families cause for concern; due to the fact that this facility failed to meet the basic needs of this patient.  Hopefully, the disclosure of poor care (as well as the $20,000 fine imposed against this facility) will cause Edwardsville to improve their documentation and re-commit themselves to providing necessary care for all of their patients.

Nonetheless, I am sure that this incident is not isolated.  If you believe your loved one was mistreated, abused or neglected at Edwardsville Terrace, I would honor the opportunity to speak to you about the situation and your legal options.

Related:

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Improper Transfer Leads To Broken Arm

First Quarter 2010 Illinois Nursing Home Violations Released

• Email This
• Print
• Comments
• Trackbacks

Too little, too late-- best summarizes Pilgrim Haven Health Facility of Los Angeles, reaction to fall-prevention measures suggested by a patient's physician and the facility itself.  The omissions appear to be responsible for the fall-related death of an 85-year-old man and have initiated a substantial fine by the California Department of Health.

In the course of investigating the death of the elderly patient, authorities determined that Pilgrim Health made numerous errors with respect to its medical treatment of a patient with a history of falling. 

After an initial fall in October, 2009, fall precautions were order by the man's physician and by Pilgrim Health itself.  The physician instructed the nursing home to use an electronic fall monitor on the patient and the facility noted that the man should have his walker within reach at all times and should further be supervised while walking.

Just two months later, the man was involved in a second fall at the facility without the knowledge of the facility staff--- and away from his walker.  The facilities initial examination of the man appeared to show little with respect to visible injuries.  However, in the evening following the fall, the man's injuries quickly became apparent. 

During the evening following the fall, the man's condition began to deteriorate becoming pale, motionless and began vomiting.  Even after staff at Pilgrim Haven noted the change in the man's condition, they failed to immediately conduct a full neurological assessment or notify the man's doctor as to his change in condition.

Hours after the extent of the man's injuries began to be apparent, he was transported to a hospital where he died shortly after his arrival.  A CT scan determined that the man's death was due to bleeding in his brain that investigators attribute to his previous fall.

As a result of the fall, Pilgrim Haven was fined $100,000 -- the maximum fine allowable under California law.  Pilgrim Have is part of the American Baptist Homes of the West. Read more about this nursing home fall as reported by the L.A. Times here.

Head Injuries From Falls

As we age, our bodies lose some of the protective fluids that cushion our joints and even our brains putting us at risk for more serious type of injures that are usually not associated with younger people.  For this reason, older people are at a heightened risk for sustaining head injuries in fall.

Even a minor head trauma can put excessive force on the brain that may result in inter-cranial bleed (commonly referred to as a subdural hematoma).  Subdural hematomas occur when blood vessels burst in the space between the brain and the outermost membrane that covers the brain (dura mater). The collection of blood forms a hematoma, which puts pressure on the brain tissue.  When the pressure builds and goes unrelieved, people can suffer serious injury or even death.

Nursing homes must be tuned in to patients who sustain even minor head-related trauma and be mindful of the symptoms of a subdural hematoma.  When identified early, patients who sustain a head injury are more likely to have better outcome and survival rate.

Related Nursing Homes Abuse Blog Entries:

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

'Poor Judgment' To Blame For CNA's Failure To Implement Fall Precautions In Minnesota Nursing Home Death

• Email This
• Print
• Comments
• Trackbacks

A demented sense of humor amongst nursing home workers at Valley View Skilled Nursing Facility seems to have backfired-- and has landed a group of them jobless and facing criminal charges. 

The fallout stems from an incident in which four employees at the California nursing home, covered dementia patients at the facility with lubricant from head to toe, making the patients slippery for staff on the next shift to handle. 

In the wake of the incident and following investigations from the nursing homes parent company, Horizon West Healthcare and the California Attorney General's Bureau of Elder Abuse, it was determined that four nursing home employees were directly responsible for the prank and two other employees sat by idly and did nothing when they saw their co-workers acting inappropriately.

Regardless of their role in the incident, all face misdemeanor charges of injury to an elder or dependent adult, battery committed on an elder or dependent adult and battery committed on hospital property. Read more about this case of nursing home abuse here.

Certainly, there will be those who think these criminal charges are an over-reaction for an incident in which there was no physical harm to these patients. Despite such claims, these obviously disrespectful acts indeed are a form of abuse and are frequently the beginning of progressively more daring stunts.  What do you think?

Related Nursing Homes Abuse Blog Entries:

Nursing Home Abuse: Hidden Camera Catches Nurse Yanking The Wheelchair Of A Disabled Patient

Criminal Charges Filed Against Assisted Living Employee In Relation To Resident Suffering Burns While Eating

Criminal Charges May Be Brought Against Chicago-Area Nursing Home In Connection To Resident's Death

Three New York Nursing Home Employees Charged With Abusing Elderly

• Email This
• Print
• Comments
• Trackbacks

Allowing a nursing home patient to sit comfortably in their wheelchair in a hall or perhaps in an outdoor area of the facility seems like a pretty innocent act-- right?  I mean aren't patients in wheelchairs entitled to a little fresh air or just hang out in an common area with other patients?

Despite the seemingly harmless act of sitting in a wheelchair, nursing home employees need to take steps to ensure the safety of these handicapped residents-- even if they appear to be sitting idly.  Too often nursing home employees take for granted that wheelchair patients' limited mobility puts them at increased risk for falls and collisions with their surroundings at the facility.

A recent situation involving a disabled nursing home patient made the news, after the woman sustained serious injuries in a fall from her wheelchair.  The woman's injuries include: fracturing her collarbone, sustaining a closed head injury and suffering multiple bruises and abrasions.  The incident occurred at the Jewish Home of Eastern Pennsylvania. 

The incident gave rise to a lawsuit against the facility that alleges aides left the patients wheelchair unattended on a sidewalk that had a decline which caused the wheelchair to roll and crash into a nearby street.  Read more about this nursing home lawsuit involving an injury to a wheelchair-bound patient here.

The need to supervise patients in wheelchairs

Putting a patient in a wheelchair does not relieve nursing home staff of their duty to provide ongoing supervision.  Depending on the patients physical and mental capacities, they should provide a level of supervision appropriate to the individual.  In most cases, providing a safe environment for wheelchair patients includes:

• Making sure locks on the wheels are engaged when the patient is sitting in one area or is incapable of appreciating harm
• Parking wheelchairs in areas where the ground is level
• Keeping patients in wheelchair away from congested areas when they could be pushed or bumped
• Properly utilizing leg braces to make sure they do not have the patients legs in a manner where they could catch on things
• Keeping patients away from fall hazards and unguarded stairways

Certainly, wheelchair-bound patients are entitled to freedoms, yet it remains the responsibility of nursing home staff to supervise them and assure that the wheelchair use does not put them at a heightened risk of harm to themselves or others.

Related Nursing Homes Abuse Blog Entries:

2 Residents Fall From Wheelchairs With 2 Days At Nursing Home

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Nursing Home Worker Charged With Raping A Wheelchair-Bound Patient At Rhode Island Facility

Can a nursing home tie my dad to a wheelchair if he has had episodes of wandering around the facility?

• Email This
• Print
• Comments
• Trackbacks

Unknown to many, there are people in nursing homes that require skilled nursing care for reasons aside from old-age and de-conditioning.  A substantial number of nursing home patients require short-term and long-term care due to various types of personal injuries and conditions related to negligence of others. 

In some circumstances, we have successfully prosecuted many ancillary cases despite the fact that we may have been initially contacted to investigate a situation involving nursing home abuse or neglect. Below is a sampling of the personal injury matters we have prosecuted on behalf of nursing home patients.

Medical Malpractice:

Errors made by physicians and hospital staff can permanently cripple and similarly cause complications that require ongoing care.  In addition to general negligence on behalf of a physician, medical malpractice may encompass: surgical errors, pharmacy errors, hospital mistakes and nursing negligence.

Automobile / Trucking Accidents:

Despite strides in automobile design safety, automobile accidents continue to be a major source of serious personal injury-- particularly amongst the younger population.  Drivers, passengers and pedestrians involved in automobile accidents remain susceptible to orthopedic and neurological injuries. 

Industrial Accidents:

Hard working men and woman are injured on the job everyday. A sizable contingent of working people may suffer a significant injury due to a fall, electrical shock or due to the negligence of another worker on the job site.  Some of these situations result in serious injuries such as: brain injuries, burn injuries and paralysis.  Industrial accidents may give rise to a lawsuit under a theory of general negligence or may be maintained under a law specific to the industry such as: FELA, workers compensation, Jones Act or Federal Tort Claims Act. 

Asbestos Exposure:

Some nursing home patients require specialized breathing treatments due to a condition called Mesothelioma. Mesothelioma is a unique type of cancer in the lining of the lungs that is almost exclusively found in people who have been exposed to asbestos.  Many cases of Mesothelioma are not diagnosed for decades after the exposure period.  Many laborers in the following industries are frequently diagnosed with Mesothelioma: automobile industry, steelworkers, ship builders and insulation to name a few.

Products Liability:

Unsafe products continue to make their way into our homes and workplace.  In some circumstances the manufacturer is aware of how they can improve the safety of the product, yet they are hesitant to due to because of the increased cost.  In some cases where a manufacturer is negligent in the design, manufacture or in providing warnings related to product usage and a person is seriously injured all medical expenses-- including nursing home case can be recovered as part of the claim.

Do you have a viable case against another party?

While not every accident-related matter may be compensable, it is important to contact a personal injury lawyer as soon after an incident as feasible.  Many cases must be filed within a specific statute of limitations that varies according to jurisdiction.  However, in the cases of a disabled person, the statute of limitations can be extended beyond the 'normal' statuary period to allow a lawsuit even after the time for filing a case has expired.

• Email This
• Print
• Comments
• Trackbacks

According to a January, 2010 report from the Illinois Department of Health, Colliinsville Rehabilitation & Health Care Center made several errors with respect to handling incidents in which a patient was sexually assaulted by another patient.

The nursing home survey revealed that in November, 2009 a convicted felon as admitted to the facility as he was accompanied by his parole officer.  Management at Colliinsville was also aware of the man's criminal background and existing diagnoses of:

• Alcohol abuse
• Cocaine dependency
• Hepatitis C
• Antisocial personalty disorder- a perverse pattern of disregard for and violation of, the rights of others that begins in early adolescence and continues into adulthood

Even with the man's questionable background, officials allowed the man to enter the Collinsville Rehabilitation & Health Care Center as a patient.  However, within just a few weeks of his admission to the Collinsville, the man was involved in numerous incidents which call into question the facilities judgment in admitting him.

There were multiple reports where the new patient entered the room of a female patient, closed the door and began to grope the patient.  Despite the fact that the female patient voiced her concerns about her safety due to the acts of co-resident, the facility failed to take any interventional acts.  Moreover, despite the patients complaints of threats to her safety to staff on the floor, the staff never communicated the safety concerns to the director of nursing or other management at Collinsville.

In response to the multiple errors made at Collinsville Rehabilitation & Health Care Center, the Illinois Department of Health cited the facility for violations related to the Nursing Home Care Act.  The agency also issued at Type A Violation and fined the facility $20,000.

Related Nursing Homes Abuse Blog Entries:

Another Sexual Assault Of A Nursing Home Patient At The Hands Of A Convicted Felon

More Staffing & Stiffer Fines. Welcome To The New Way Of Doing Business For Illinois Nursing Homes?

First Quarter 2010 Illinois Nursing Home Violations Released

• Email This
• Print
• Comments
• Trackbacks