Nursing Homes Abuse Blog - By Jonathan Rosenfeld

We'd like to think that beauty of our jury system is that it allows reasonable people to hear evidence about a dispute and render a rational decision based upon the evidence presented.  After all, the people on the jury are in the best position to render a fair and impartial decision--- right?  Similarly, if a jury comprised of fair and rational people can arrive at one decision, how could anyone think otherwise?

The concept of diverging views of in civil lawsuits is nothing new, but I was again reminded of the extreme disparity between the findings from a jury and those from nursing home surveyors in a recent article written by Michael Booth in The Denver Post, "Jury says man died due to Rocky Ford nursing home's negligence; state differs". 

The situation Booth contrasts is the recent situation involving a nursing home negligence lawsuit in Colorado where a jury awarded the family of a deceased resident $3.2 million due to the facilities alleged negligence in allowing a resident to develop stage 4 pressure sore.  Meanwhile, the same situation was investigated by authorities from the state's Health Department and the facility was not cited for any type of "deficient practice because the investigation did not substantiate current deficient practice."

If that mumbo-jumbo was too much for you to understand--- like myself--- it simply means that the facility was found not to be negligent in relation to the care of this patient. 

No deficient practice?  While I'm sure there are medical experts out there that opine that the development of a stage 4 pressure sore (the most advanced stage), the overwhelming medical literature suggests that a stage 4 pressure sore is a medical complication that simply should not occur.  In fact, Medicare has deemed stage 3 and state 4 pressure sores that develop during a hospitalization to be simply inexcusable that they are part of the list of 'never events'-- medical complications deemed so inexcusable that hospitals will not be reimbursed by medicare when they occur at their facilities.

Perhaps the surveyor(s) involved in the investigation of this matter were simply having an 'off day' at the time they conducted their inspection? While indeed a possibility, I'd suspect that it's more unlikely--particularly in situations such as this-- where there are relatively 'clear cut" situations involving poor nursing home care, my hunch is that there is a more drastic underlying problem that needs to be addressed when it comes to calling out poor nursing home care.

While situations such as this can be discouraging for families who wish to report episodes of poor nursing home care, I continue to suggest to families that they indeed need to report all episodes of poor nursing home care or injuries to the regulatory agencies within their states.  While the ultimate findings of the agency may lack the decisiveness that many families crave, the investigations may still turn up valuable evidence for use in civil matter.

Considering that some of these state investigative reports lack any credible findings, it may be a good thing that they are generally inadmissible in civil trials.  Thankfully, there still are some dedicated jurors who are able to use their common sense to determine right from wrong.

Related Nursing Homes Abuse Blog Entries:

Jury Awards Family Of Deceased Nursing Home Patient $3.2 Million In Response To Bed Sore Lawsuit

Nursing Home's Conduct In Wrongful Death Case Angers Jury---- To The Tune Of $200 Million

Nursing Home Lawsuits: Do they represent isolated events or are they representative of poor care?

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

I've got a confession to make.  Sometimes when I'm in my office I make personal calls.  Sometimes I even take time away from my day to forward email chains of perverted jokes to friends.  Other times, I'll talk with my colleagues about my weekend plans--- sometimes even on a Monday.  I'd imagine my style of intermixing personal plans during the course of my workday is fairly normal as many of us spend a good chunk of our waking hours plugging away at our jobs.

Since its my blog, I generously chose to call these daily diversions 'personal plans', but surely these could be aptly categorized simply as 'distractions'.  While for all these mini-distractions I encounter--- or create for myself in the course of the day, I would at least like to think that these distractions aren't really that problematic because I still make doing what needs to be done at my job priority number one.

I began to consider the daily distractions almost all of of face during the course of the day-- both at work and at home--- when I read about an almost unbelievable episode of extreme nursing home neglect involving staff at a Iowa nursing home.  An internal video shot at All American Restorative Care in Washington, IA depicts what I'd consider to be a situation involving far more than a healthy dose of distraction during a Christmas party at the facility.

The video from the facilities video-monitoring system confirms that over the course of 48 minutes, at least four nursing home employees walked past a patient who had fallen to the floor and struck her head. While two of the employees did have the courtesy to ask the woman if she was 'ok', no one actually initiated any follow-up to confirm that her claims were indeed accurate.

An investigation by officials from the state confirmed the rampant distraction--- or more accurately-- complete neglect of the the patient.  Equally alarming, the state's investigation revealed that even though the patient appeared to be "pretty out of it" (indicative of a possible head injury), several nursing home staffers elected to bring her back to her room without any neurological assessment.

Approximately 90 minutes after the woman was taken back to her room, staff finally chose to send her to an emergency room where the patient was treated for a laceration to her head. 

Whatever the underlying reasons are for staff literally ignoring an obviously injured patient, their behavior is without excuse and is simply emblematic of an environment where patient needs are ignored.  Particularly with an injury to her head, this patient is truly lucky that her injury wasn't exacerbated by the distracted--- err--- grossly neglectful staff members.  Clearly, these people need to be reminded about focusing on their jobs.

Related Nursing Homes Abuse Blog Entries:

Why Do So Many Nursing Home Patients Suffer Fall-Related Injuries When Preventative Techniques Are So Easy To Implement?

Nursing Homes Post-Fall Care Of Injured Patient Criticized By State Investigators

Rapid Decline For Elderly Nursing Home Patients Following Fall-Related Injuries

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

http://www.nursinghomeinjurylaws.com/common-nursing-home-injuries/falls/

http://www.rosenfeldinjurylawyers.com/practice/nursing-home-injuries/nursing-home-falls/

On Friday, April 13, Louise Jones received the call that every daughter dreads.

“They told me that my mom had taken a blow to the head,” said Jones, whose mother, Elizabeth Kennedy, is a resident at the Maple Grove Health and Rehabilitation Center in Greensboro, NC. “She’s 86 and defenseless, and I wasn’t there to protect her.”

According to Greensboro’s local FOX affiliate, staff at Maple Grove called police after noticing a large bruise on Kennedy’s head. It was unclear from the report who noticed the bruise, or why the facility decided to reach out to authorities when it did. A photo used in the FOX report shows a 2- 3-inch purplish mark above Kennedy’s right eyebrow.

“I felt all kinds of emotions when I saw [the bruise] - hurt, anger, revenge,” said Jones. “She’s like my child. She can’t get up. She can’t walk. This is the coldest anybody could be. They’ve got to be of the devil. They have to be.”

Jones said that Maple Grove offered to move her mother to another facility, but that she declined, seeing that her mother’s doctor can only visit her in Maple Grove.

Medicare’s “Nursing Home Compare” Web site gives Maple Grove three out of five possible stars. According to Nursing Home Compare, Maple Grove only earned two out of five stars in the area of Health Inspections. During the time period between December 1, 2010 and February 29, 2012, the facility racked up a a total of 10 violations - more than double the state average of 4.

“If [Maple Grove] has anything Godly in them, maybe they can come forth on their own, and maybe it can make things a little bit easier,” Jones said. “But I don’t think it will ever justify how I feel, what it’s put me through, or what my mother has endured.”

Maple Grove ignored a FOX reporter’s request for comment.

Related Nursing Homes Abuse Blog Posts:

Primer on North Carolina Nursing Home Laws
Elder Abuse: Why Bruises Can Be Tell-Tale Signs of Poor Care
When Bruises Can’t Speak For Themselves: The Difficulty Proving Abuse of Disabled Nursing Home Residents

                                     
Five days after it banned new patients from entering the Bristol Nursing Home in Bristol, TN, the state Health Department decided the facility was “in compliance” and could accept residents again.

“[Conditions leading to] ‘immediate jeopardy’ citations have been corrected,” said the Health Department’s announcement, in late April.

“Immediate Jeopardy” situations are “crisis” situations in which there’s either a potential for harm or actual harm done to one person. Once they’ve identified an “Immediate Jeopardy” situation, regulators are required by federal law to make sure the situation doesn’t continue.

“The principles of Immediate Jeopardy apply to all certified Medicare/Medicaid entities, and need to be followed for all individuals receiving care and services in those entities,” said the Centers for Medicare & Medicaid Services Web site.

An examination of four Tennessee Health Department surveys revealed that Bristol Nursing Home failed to:

• Administer proper medications
• Keep residents’ toenails at proper lengths
• Contain violence among residents

According to Tennessee Health Department documents, 30 percent of all nursing homes - about 30 total - had substantiated complaints in 2010.

To read more about immediate jeopardy and other important nursing home terms, visit:

Nursing Homes Abuse Blog: Terms to Better Understand Your Nursing Home
Nursing Home Injury Laws: Glossary

When it comes to medical complications that realistically pose a serious threat of disabling--- or even killing-- patients in nursing homes and hospitals across the country, few conditions can compare to pressure sores.  

As innocent as the term may sound, when "pressure sores" progress, they should perhaps be more accurately referred to as "large open wounds" when they progress to their more advanced stages.  An advanced pressure sore remains one of the indelible emblems of poor care--- when the skin and tissue in the area of the wound gives way to a large opening in the body where the underlying organs and bone may be visible.

What makes pressure sores uniquely disturbing compared with other medical complications is that patients at many medical facilities are no less at risk for developing this complication than they may have been 10, 20... or even 100 years ago!  Unlike other medical complications that have been drastically reduced or eradicated with the implementation of medication and technological advancements, pressure sore prevention relies primarily on the backs of the staff members whom are responsible for caring for immobile patients.

By moving a patient from their bed or wheelchair at regular intervals, the bodies natural circulatory process of bringing is allowed to operate as nature intended.  Life-sustaining blood flow to brings nutrients to tissues in the body which may not have been receiving it due to unrelieved pressure on the person's body.

Unfortunately, the anatomical differences in people combined with the unique positioning of the individual in a bed or wheelchair commonly results in situations where the first indication of the build-up of unrelieved pressure on the body--- is a pressure sore in its primary stages.  While, pressure sores in their early stages may be healed with timely care-- too often early stage pressure sores simply progress to more advanced wounds when staff fail to make necessary interventions or in circumstances where patients are quite ill.

Without a tool to determine who needs to be moved--- and when, medical facilities typcially use a one size fits all approach and (theorretically) move patients at regular intervals .  While the regular "turning" may serve its purpose in terms of preventing pressure sores in a substantial number of patients, the frequency may be insufficient or impracticible for others. 

Perhaps the identification of the early stages of pressure sores is about to gets a much needed gift in the form of new medical technology?

I recently read about a new product to help in the assessment of mobility (and circulation) in bed-ridden patients.  The Mobility Monitor is a patient monitoring system used beneath the mattresses of physically compromosed patients, to alert staff when a patient needs to be moved-- or when they can rest.

Beginning in June, the system will be commercially available to nursing homes and hospitals as a much needed tool in the arsenal of pressure sore prevention.

I look forward to seeing this promising device in nursing homes and hospitals.  While the device promises to improve patient care, I would think that such a device would be welcomed by many facilities as the device appears to take much of the subjectivity associated with nursing care out of the patient-care equation and staff can focus more of their energy on actively listening to what the patient needs as opposed to worrying about adhering to a strict schedule.

Read more about the Mobility Monitor here.

Related Nursing Homes Abuse Blog Entries:

Bed Sore Prevention: Staff Must Turn & Reposition Bed-Ridden Patients At Regular Intervals

What devices or products can be used to prevent or relieve bed sores?

Medical Malpractice Lawsuits & Hospital Acquired Pressure Sores

$5 Million In Punitive Damages Awarded To Widow In Bed Sore Case Against Nursing Home & Hospital