Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Given the frequency (approximately 80+% of all nursing nursing home patients will experience a fall this coming year) with which nursing home falls occur, facilities must be on the lookout when it comes to implementing fall prevention techniques in order to improve patient safety.  Too often, the prevention comes too late-- if at all.

Here are our most popular fall-related entries over the past year:

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

Falls are a common problem facing elderly people in and out of nursing homes. By some accounts, every elderly person in America will fall at least one time over the course of the next year. Many of these falls will cause injury and some will even cause death.

In the case of falls occurring in the nursing home setting, many clients and their families focus their attention on tying a specific number of falls to a facilities responsibility. Truth be told, there really is no magic number when it comes to identifying a specific number of falls after which a nursing home or hospital becomes responsible....

Never Event #1: Hospital Falls & Trauma

Falls in trauma top the list of preventable medical conditions in hospitals, accounting for 193,566 incidents in 2007. Falls in hospitals (and similarly in nursing homes) are deemed to be preventable by Medicare because with proper fall/risk assessments and staff assistance most falls in hospital could be avoided. A number of factors should be addressed by a hospital to determine if a person is at risk for falls:...

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

The Minnesota Department of Health released an investigative report concluding a resident of Presbyterian Homes of Arden Hills Nursing Home sustained a broken neck due to a fall or other trauma at the facility. The investigation follows the death of 91-year-old Gladys Gall, a resident at the facility.

Despite the fact no federal or state nursing home violations were identified, investigators still determined there was ample circumstantial evidence to conclude the nursing home was at fault in the injury and subsequent death of Gall. On April 18, 2008 Gall was admitted to an emergency room after complaining of head and neck pain. A CT scan confirmed Gall's pain was related to a cervical fracture. On April 28th, Gall died from complications related to the cervical fracture....

What Is Hypostatic Blood Pressure & Why Is There An Associated 'Fall Risk'?

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low....

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

The most dangerous part of the day for many nursing home patients may be getting out of bed in the morning. When staff fail to supervise or provide proper assistance to nursing home patients during transfers, patients are at risk for falls or being dropped by staff.

Disabled nursing home patients and those with physical limitations must be carefully monitored to avoid injuries while being transferred from one device to another. Some of the commonly encountered situations where patients are injured include:...

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Frequently undiagnosed and under-appreciated, falls amongst the elderly can frequently result in brain bleeds or technically termed 'subdural hematoas'. Because elderly are predisposed to developing subdural hamatomas, staff in nursing homes and hospitals need to be tuned into the symptoms and when to seek additional medical care....

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

A fracture is a broken bone that requires medical attention. Fifty percent of women over age fifty and twenty-five percent of men over age fifty will suffer from an age-related bone fracture sometime in their lifetime.

Elderly people are particularly susceptible to broken bones because as bones age, they lose the ability to resist the formation and growth of cracks that can lead to bone breaks because they cannot withstand as much pressure as younger bones. Unfortunately, as we age, our bodies ability to heal fractures is compromised....

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls

Coumadin (generic name - Warfarin), is an anticoagulant (blood thinning medication) that is commonly used to help treat and prevent blood clots that could cause a heart attack, stroke, or pulmonary embolism. This prescription medication works by blocking the creation of certain clotting mechanisms, which prevents blood clots from forming. The goal of warfarin therapy is to decrease the clotting tendency of blood but not to prevent clotting altogether....

If your loved one suffered an injury related to a fall at a hospital or nursing home, the facility may be responsible for their injuries.  You can always call our office to discuss the potential matter, free of charge.  Toll-free across the country (888) 424-5757

Although the news regarding the horrific physical and emotional impact of bed sores (also called decubitus ulcers, pressures sores or pressure ulcers) surely is on all respectable medical professionals radar screens, bed sores in nursing homes and hospitals continue to plague individuals in all demographics.  In order to improve patient care, bed sore prevention must be a priority at all nursing homes and hospitals.

Should a bed sore develop, staff must be diligent in identifying the wound as quickly as possible an implement the use of medical equipment such as pressure relieving mattresses  and other pressure relief devices such as heel protectors to prevent the wounds from advancing.

When bed sore are not timely treated, the wounds may progress and become an advanced stage bed sore. A stage 3 or 4 bed sore typically requires more aggressive interventional medical treatment may be required such as surgical debridement, flap reconstruction or a diverting colostomy may be necessary.

By the time significant medical treatment his utilized, many patients are already suffering from complications such as: osteomyelitis, amyloidosis, gangrene or sepsis. 

In addition to the pain that accompanies bed sores, the medical complications may claim the life of the person.  In my practice, we commonly represent families in wrongful death lawsuits for people who have developed bed sore during an admission to a hospital or nursing home.

Many of these commonly encountered situations are discussed at BedSoreFAQ.com, where we receive thousands of visits every month from concerned family members and care givers. If you have a question, not discussed, feel free to contact me for a no-obligation consultation. (888) 424-5757. Toll-free. Anywhere

I am grateful to our readers who continually supply me some great topics to write about.  I also receive questions from readers regarding a particular situation they may be experiencing.  I try to answer every question I get or direct readers to a resource to get more information.  I have put many of commonly encountered questions in our FAQ category for easy access. Don't worry, I never disclose your personal information.

Here are some of the most popular FAQ's:

• How do I get a copy of medical records from a nursing home?

One of the most important steps in determining if a cause of action exists against a nursing home or hospital is to review the medical records. The records will help determine what-- if any-- mistakes were made by the facility in the care of the individual.

Getting medical records from a nursing home, physician or hospital can be a daunting task due to privacy regulations (HIPPA) and misunderstanding of the laws that apply to obtaining the records-- both on the part of the person requesting the records and on the part of the medical facility.

• Who is responsible for deciding whether an assisted living facility can properly care for a resident?

Assisted living facilities are generally governed by state law. In Illinois, assisted living facilities (ALF's) are licensed, regulated, and inspected by the Illinois Department of Health (IDPH). The IDPH ensures that all ALF's in Illinois comply with the provisions of the state Illinois Nursing Home Care Act (210 ILCS 45). IDPH is responsible for the initial licensing and continued re-certification and inspection of the facility.

If a patient feels that his or her resident rights are being violated, a complaint may be filed with IDPH, which may prompt a complaint investigation to ensure that the facility is properly caring for all residents.

• What is an advance directive and should I have one?

 An Advance Directive is a written statement about how you want medical decisions to be made in the future if you can no longer make them yourself. Federal law requires that you be told of your right to make an advance directive when you are admitted to a health care facility.

• Are nursing home patients protected under federal law?

Although many nursing home patients frequently feel trapped within the situation they are currently in, nursing home patients actually have many rights granted to them under federal law. Federal law empowers nursing home patients to make decisions with respect to their medical treatment and personal care.

Who Regulates Nursing Homes?

In most states, nursing homes are regulated by a combination of state (Department of Health) and federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services [CMS]). Each agency has its own regulations that control all aspects of the nursing home including: resident care, staffing, policies and procedures and medical equipment.

Because nursing homes are responsible for complying with state and federal regulations, agents from either agency conduct inspections of the facility to assure compliance with the regulations. These inspections are called 'surveys' and are generally done unannounced at least one time per year. Surveys may be conducted more frequently at facilities with a history of prior violations or in response to a complaint regarding resident care.

• What Are Signs Of Nursing Home Abuse?

Physical, mental and sexual abuse are forms of abuse encountered by nursing home residents across the country. Sadly, some of the most commonly abused nursing home residents include those who are physically or mentally disabled and have no way of fighting off a perpetrator.

Remember, you know your loved one better than anyone else. If you suspect mistreatment or abuse immediately report the situation to local police and/or ombudsmen. The reality is that most episodes of elder abuse go unreported.

• What Steps Should I Take Before Meeting With A Nursing Home Lawyer?

When you become aware of mistreatment of a nursing facility it is important to get your loved one the medical treatment they need and then get into ‘fact collection mode’. In fact collection mode, you are beginning to collect information about the incident, acts of the nursing home staff and medical condition of your loved one. Doing some preliminary work before you meet with a lawyer will prove for a more effective meeting.

Don’t assume you will remember all facts regarding the incident. As time goes on, your memory will begin to fade. The following steps will help you organize your thoughts during a stressful time and to give an attorney the information he needs to work best on your behalf.

Have a question regarding nursing home injury or patient rights?  Give me a call or use our contact form to discuss.  (888) 424-5757
 

Elmwood Care is a large 245 bed nursing home located in Elmwood Park, IL, a suburb of Chicago. According to the government’s Medicare website, the facility received only one out of five stars, which is a much below average rating. The facility received only one out of five stars for health inspections, which is a much below average rating. In the past year, the nursing home had 48 health deficiencies, which is an alarmingly high number of deficiencies. This is 40 more deficiencies than the average number of health deficiencies in Illinois and in the United States. This is also a serious increase in the number of yearly deficiencies, up from the 13 health deficiencies in the previous year and the three health deficiencies two years ago.

The nursing home has an obligation to provide a safe and secure facility for its residents and to provide proper care and supervision to achieve and maintain the highest level of well-being for its residents. Nursing homes must meet the Requirements for States and Long Term Care Facilities outlined in 42 CFR Part 483.  

Elmwood Care received numerous violations for both quality of care and the facility environment. According to survey reports the facility received violations for failing to:

• Protect residents from mistreatment, neglect, and/or theft of personal property
• Keep each resident free from physical restraints, unless needed for medical treatment
• Give each resident care and services to get or keep the highest quality of life possible
• Give residents proper treatment to prevent new pressure sores (also called: pressure ulcers, decubitus ulcers or pressure sores) or heal existing pressure sores
• Make sure that the nursing home area is free of dangers that cause accidents

According to survey reports, Elmwood Care failed to prevent the spread of infection by failing to implement its complete infection control program for residents with infections on two of the three floors in the facility. Nursing home staff members made several errors in technique for the isolation protocol for residents who were in isolation. These errors included allowing visiting family members to use dirty gowns to pick up new clean gowns, lack of running water in isolation room for family and staff to wash their hands, allowing family members to throw away dirty gloves in another resident’s room (which was not an isolation room), and staff members failing to wash their hands before and after entering an isolation room. Preventing the spread of infection in nursing homes is very important because many residents have weakened immune systems due to illness or age.

Nursing home residents have the right to personal privacy and confidentiality of personal and clinical records. During the survey, staff members failed to provide visual privacy for several residents. This included failing to close privacy curtains when providing treatment for residents and also failing to close window shades on windows that could be seen from nearby homes and businesses.

Residents have the right to be free from any physical restraints imposed for the purposes of discipline or convenience, and not required to treat the resident’s medical symptoms. The facility did not meet this requirement by failing to complete the following activities for several residents: assess residents for the medical need for physical restraints, obtain physician’s orders for restraints, create care plans and provide for a reduction of a physical restraint, release the restraint every two hours, and assess alternatives to provide the least restrictive measures. These failures led to one resident developing an injury to his big toe that later developed into a pressure sore from the use of a side rail restraint. This also resulted in the resident needing several restraints at the same time including the use of a chemical restraint. During the survey, the facility was unable to provide an accurate number of residents with physical restraints.

The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source are immediately reported to the administrator of the facility and to other officials in accordance with State law. This requirement was not met when the facility failed to thoroughly investigate injuries of unknown origin for one resident. In one incident, a resident suffering from Schizophrenia and Dementia was found on the basement floor of the smoking room in the middle of the night. The resident complained of left leg pain and was brought upstairs without being assessed by a nurse before being moved.

After assessment, the resident was sent to a hospital. The nurse notes document that the resident told staff that a tall man had pushed him on the floor. However, there was no investigation or statements of how the resident suffered when the hip fracture. The facility faxed an initial incident report to the state, but failed to conduct an investigation or submit a final report of the investigation to the state.

Elmwood failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. The survey revealed odors, unsanitary storage of medical supplies, and failure to maintain a clean, sanitary, and orderly environment. Findings included: dirty shower chairs, food stored in refrigerator with medication, food on activity floor, odor in bathroom, clogged bathroom sink, sewage odor in nursing supply room, no thermometer in freezer, nursing supplies stored on floor of utility room, unclean freezers, dirty feeding tube pump, dark brown stains in some resident bathrooms, urine smell in some resident rooms, cluttered equipment store rooms, and strong urine odor in hallway.

The facility is required to provide residents with the appropriate treatment and services to maintain or improve the residents’ abilities. The facility failed to meet this requirement because it lacked any restorative program, which affected every resident with restorative needs. The lack of restorative nursing program led to a physical decline in the following residents:

• Resident 1 – lack of positioning devices which led to pressure ulcers.
• Resident 5 – decrease in range of motion and new pressure ulcers
• Resident 20 – lack of assessment and devices led to the development of a wound.
• This lack of proper restorative nursing program also led to a failure to evaluate residents to ensure that the least restrictive physical restraints were used.

The facility must ensure that a resident who enters a facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable. The facility must also ensure that a resident who suffers from pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new pressure sores from developing.

Elmwood Care did not meet this requirement as evidenced by its failure to monitor residents at risk for pressure sores, provide devices to prevent the development of pressure sores, provide care and services to residents with pressure sores to prevent the spread of infection and promote healing, and provide education and training to direct care staff in the policy and procedure for wound care. These failures resulted in immediate jeopardy.

The facility must ensure that the resident environment remains free of accident hazards and ensure that each resident receives adequate supervision and assistance devices to prevent accidents. The facility failed to meet this requirement by failing to ensure that residents received adequate supervision to prevent falls and failing to address the increased number of falls per month or the types of interventions being taken to decrease the number of falls.

These failures resulted in a significant number of falls, with one resident’s fall requiring treatment at an Emergency Room for a head injury. These failures resulted in immediate jeopardy. It is important that nursing home staff reduce the chance of accidental falls because elderly nursing home residents are more susceptible to bone fractures and injuries because of weak bones.

Elmwood Care received two out of five stars for nursing home staffing. The facility has 177 total residents, compared to the national average of 94.7 and the Illinois average of 103.9. Each resident received 1 hour 7 minutes of nursing home staff time per day, which is less than the Illinois average (1 hour 12 minutes) and less than the national average (1 hour 24 minutes).

This one-star rated facility had an exceedingly high number of deficiencies over the past year, which calls into question the facility’s ability to provide residents the proper care and services to achieve the best possible physical and mental health of its residents.

If you have a friend or family member who has sustained in injury during an admission to Elmwood Care or any other skilled nursing facility, we would be honored to speak with you about the circumstances.  All consultations are confidential and free of charge. (888) 424-5757

Sources:

Medicare website

IDPH website

Related:

Third Quarter Illinois Nursing Home Violators

Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

Pressure Ulcer Treatment: Surgical Debridement

In cases involving nursing home abuse and neglect, filing a complaint with a state agency regarding the incident can be incredibly important with respect to getting answers about how an incident occurred and securing valuable information should the matter be litigated in the future.

John Kormanik who produces an excellent Nursing Home Abuse Advocate Blog, recently made some extremely useful suggestions before initiating the complaint with your state agency.  Here are John's suggestions:

• Provider / Facility Name and City
• Name of Patient/Resident
• Detailed Statement of Care Provided And Any Negative Outcomes
• Names of Witnesses
• Your Name and Contact Information; unless you wish to remain anonymous.

Of course, if I may add my own two cents, I would add the follow:

Report the incident as soon as feasible

Reporting an incident as soon after it occurs provides investigators with the best opportunity to access records, witnesses and staff with knowledge.  In many circumstances, facilities have such high staff turnover that, a witness to an incident may be long gone-- within months of an incident.

Be as succinct at possible

After fielding calls all day, do you really think the men and women on the other end of the line want to hear all the details of your favorite sushi restaurant or how Grandma Sue is a huge Cubs Fan?  

Seriously, report the information that is relevant to the event and stop.  Too much information will just detract from the seriousness of your complaint.

Above all, I strongly encourage people to report all situations involving questionable care or injury to your state's department of public health or ombudsmen program.  

Related:

How can nursing home ombudsmen help with problems encountered in a long-term care facility?

Nursing Home Watchdogs: Ombudsmen

Where To Report Elder Abuse

Ombudsmen In Nursing Homes

Perhaps there is no more visual reminder of abuse or mistreatment than a bruise.  The discoloration is not only ugly in appearance, but it can also be a source of pain for the individual.  Because bruising can be a relatively common occurrence in the elderly, I think its important to learn more about this medical condition and hopefully become better at identifying a bruise due to mistreatment vs. the normal aging process.

What is a bruise?

Bruises can result after an injury, a fall, or even bumping into something. A bruise (contusion) is an injury to the soft tissue that results in broken capillaries which leak red blood cells. As the heart pumps, the blood escapes to the surrounding tissues, creating a bruise. 

Bruises can surface hours or even days after an injury and can also show up on a different part of the body than was injured. Bruises are usually reddish in color at first, turning bluish-black or purple after a couple hours, then yellow, green, or brown as they heal. Because bruises involve skin trauma, they are usually painful for at least the first few couple days. 

How bruises heal.

Bruises fade gradually as your body reabsorbs the blood that leaked from your blood vessels. After an injury, you can take steps to prevent or minimize bruising. This includes applying a cold compress to the injured area, elevating the injured area, and avoiding blood thinning medications if possible. During the healing process, a bruise will fade in color, from bluish-black or purple to a yellowish green to a lighter brown before disappearing. This color change occurs as the body’s white blood cells remove the decayed blood products little by little. In most cases, bruises heal in one to two weeks, but deeper, more severe bruises can last longer. 

Bruising in the Elderly.

Older adults bruise more easily and heal more slowly than younger adults because they have fragile capillaries and thinner skin. This is because as you age, your skin becomes thinner and you lose some of the protective fatty layer that helps cushion your blood vessels. In addition, bruises in older adults can last longer than the usual 1-2 weeks, sometimes lasting for months. 

Certain drugs can also make you more susceptible to bruises, many of which are common medications for older adults. Many older adults take non-steroidal anti-inflammatory medication for arthritis including ibuprofen (Advil, Nuprin) and naproxen (Aleve), which can interfere with blood clotting. Blood-thinning medication such as aspirin, Coumadin (warfarin), and Plavix (clopidogrel) reduce your body’s ability to clot, which can cause increased bruising. In addition, corticosteroids can make your skin thinner, making you more susceptible to bruises. 

Signs of abuse?

Bruises are one of the most common indicators of nursing home abuse and neglect. This is important to note because elder abuse, including physical abuse, is on the rise. Elderly nursing home residents are vulnerable to injuries and abuse because of weakness, illness, and decreased mental cognition. 

Many times the elderly residents who are victims of abuse are unable to alert family or staff of the abuse. They might be too scared to report the abuse or too embarrassed, or even unable to remember the abuse that they were forced to endure because of a cognitive impairment. 

Residents with moderate or severe dementia may be unable to give an accurate description of abuse or neglect. Oftentimes, the context in which an injury occurs is just as important as the injury itself in screening for elder abuse and mistreatment. Because of the serious risks associated with elder abuse, nursing home staff must be properly trained to recognize signs of abuse and closely monitor residents for common signs of injury or abuse, such as bruising. 

In Illinois, if a nursing home suspects that a resident’s injury might have been caused by abuse, the facility must report the matter to the Illinois Department of Public Health, investigate the alleged abuse, and provide a copy of the investigation to the Department. (Illinois Administrative Code: Long-term care facilities – 77 Administrative Code 300.3240 Abuse and Neglect). Nursing home facilities must take all injuries seriously, especially bruises that might indicate abuse (because of bruise location, size, or re-occurrence). 

Oftentimes, it is difficult to determine if bruising is normal, accidental bruising or something worse. In order for facilities to better be able to recognize abuse, the literature must be improved by documenting normal bruising in the geriatric population. This could then provide a point of comparison for nursing home facilities and caregivers when they encounter suspicious bruises. Until then, nursing homes must err on the side of caution, investigating all injuries that seem even slightly suspicious in order to protect our elderly population. 

Although older adults bruise more easily, staff should still be concerned when residents have bruises, especially if they are in patterns or clusters, or the bruises reappear.  The pattern or shape of the bruise can sometimes provide clues as to the cause of an injury (bruises can occur in the shape of knuckles or fingers). Bruises in patterns can indicate the use of restraints (bruises on hips and arms can indicate the use of bed rails, and bruises on the wrists can indicate the use of cuffs). Frequent or serious falls are another common cause of bruising, and can indicate improper supervision of a resident. In order to provide the best possible care, nursing homes must have care plans in place to prevent residents from suffering from accidents and abuse. 

The location of the bruising may also indicate abuse. The most common locations for non-accidental injury are the face, neck, chest wall, abdomen, and the buttocks. A study in the Journal of American Geriatrics Society, Bruising as a Marker of Physical Elder Abuse, reported that bruises occurring as a result of physical elder mistreatment are often large (> 5 cm) and occur on the face, lateral right arm, and back of the torso. 

In another study published in the same Journal, The Life Cycle of Bruises in Older Adults, the study revealed that almost 90% of accidentally acquired bruises in adults aged 65 or older occur on the extremities. In a sample of one hundred adults aged 65 and older, there were no accidental bruises on the neck, ears, genitalia, buttocks, or soles of the feet. And, if the bruise was on the trunk (torso) of the body, the subjects were more likely to know the cause of the bruise. 

Therefore, nursing home staff should pay particular attention to bruises that occur on a resident’s face, arm, and back because these areas have been shown to have the greatest incidence of bruising in cases of mistreatment. 

If you notice bruising on a family member who lives in a nursing home, you should ask the staff members about the cause of the bruising. Elderly adults are vulnerable to abuse and neglect and every effort should be made to prevent or stop mistreatment. 

Resources:

Mayo Clinic: Easy Bruising, Common As You Age

Medicine Net: Bumps and Bruises

Kansas University Law School: Elder Abuse in Nursing Homes, Does Bruising Tell a Story?

Journal of the American Geriatrics Society: Bruising as a Forensic Marker of Physical Elder Abuse

98-year-old Laura Lundquist is one step closer to a jail house cell after a Grand Jury indicted the woman on murder charges related to the strangulation and suffocation death of her 100-year-old roommate earlier this year. 

A Judge ordered Lundquist to undergo an evaluation at a hospital to determine if she is competent to for a criminal trial.  

According to the District Attorney, Lundquist's roommate was found dead in her bed during a routine check.  An autopsy confirmed that Lundquist's roommate died from manual strangulation and suffocation. 

Related:

Centenarian Murdered At Nursing Home With Troubled Past

Autopsies May Help Families Determine If Their Loved One Was A Victim Of Nursing Home Neglect Or Abuse

The Colorado Supreme Court handed down a decision in the matter of Lujan v. Life Care Centers of America that invalidates nursing home arbitration agreements entered into by a healthcare proxy. The Colorado Court  held that the power to make medical decisions is different from the ability to consent settle disputes via a private system-- as in done in nursing home cases with mandatory arbitration agreements.

In Lujan, Estella Lujan's son admitted her to a Life Care Center in Colorado and signed off on an arbitration agreement along with other admission paperwork.  Three days after Ms. Lujan's admission to Life Care Center, she died.  

Ms. Lujan's family filed a wrongful death lawsuit against the facility claiming that her death was due to the facilities negligent care.  After, a lawsuit was filed, Life Care Centers filed a motion to dismiss, claiming that the lawsuit should be dismissed due to the fact an arbitration agreement was in place.

By invalidating this mandatory arbitration agreement, this wrongful death lawsuit will be able to proceed though the litigation process and eventually be heard before a jury.

Nursing Home Arbitration Clauses

An arbitration clause takes the decision of how much money--- if any -- an injured party is receive out of the hands of a jury. In an arbitration setting, one person (who is frequently pre-selected by a nursing home) determines the damages to be awarded to an individual or family. In addition, many arbitration clauses specifically limit the amount an arbitrator may award to an injured party.

Related Nursing Homes Abuse Blog Entries:

Another State Invalidates Nursing Home Arbitration Agreements

Landmark Nursing Home Arbitration Award May Cause Facilities To Re-Evaluate Patient Care

Michigan Court Strikes Nursing Home 'Arbitration Clause' And Allows Wrongful Death Case To Proceed In Court

Are Trials Really That Important?

After a one week stay at Caseyville Nursing and Rehabilitation (IL), Theresa Mary Steiner's pressure sores significantly deteriorated to the point that she had become 'septic' according to a recently filed lawsuit. 

The lawsuit claims that on December 12, 2008 Ms. Steiner was admitted to the facility with stage II pressure sores on her buttocks and early stage pressure sores on her heels.  Five days later, when Ms. Steiner was discharged, the pressure sores (also known as pressure ulcer, decubitus ulcer or bed sore) had advanced to stage IV and Ms. Steiner had become known as septic.  As a result of the sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia), Ms. Steiner died.

The lawsuit further alleges that Caseyville Nursing and Rehabilitation was negligent in the following ways:

• Failing to screen Ms. Steiner on admission to the facility
• Failed to have adequate staff to treat Ms. Steiner's wounds
• Never developed a care plan for Ms. Steiner
• Never notifying Ms. Steiner's physician as to her condition

My take:

With the obvious disclaimer (I don't know anything about the case other from what is in the newspaper), it would appear as though the Ms. Steiner's family may have a difficult time winning their case. 

As the plaintiff in this matter, Ms. Steiner's family has the burden to prove their case.   Given the fact that Ms. Steiner enter the nursing homes with clearly form pressure sores and the wounds worsened in such a brief period of time, perhaps the damages was done by the time she had entered the facility?

Sepsis and Pressure Sores

With open wounds from pressure sores, bacteria can easily enter the bloodstream and cause and infection in the body.  When the infection progresses, it may cause sepsis.

In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:

• Fever
• Low body temperature (hypothermia)
• Loss of ability to appreciate surroundings
• Cool hands and feet
• Anxiety
• Shaking
• Organ dysfunction

In order to provide patients with the best chance of recovery, facilities should identify and treat patients as quickly as feasible. If not treated properly, many patients with sepsis die shortly after the condition develops.

Resources:

Is sepsis related to bed sores? Bed Sore FAQ

Nursing home blamed for resident's sepsis St. Clair Record, December 7, 2009

Sepsis Nursing Homes Abuse Blog August 7, 2008

Nursing Home Injury Laws

Bed Sore Resources

As if we need another reason to be concerned over nursing home patient safety, an article in the L.A. Times on temporary nurses in hospitals and nursing homes will surely make you cringe.  A desire to run a streamlined operation and the inherent uncertainly of required staffing levels has resulted in a booming temporary staffing industry-- in particular with nurses.

Unregulated and widely unknown, there are an estimated 3,000 to 6,000 temp. agencies in what is believed to be an industry that takes in more than $4 billion per year--- and growing.  

Though there are certainly many highly qualified and responsible nurses who eagerly accept jobs via temp agencies due to the flexibility and generous pay and benefits, there is a noticeable group of nurses working at temp companies that pose an immediate threat to patients.

An investigation by the non-profit group ProPublica and the Los Angels Times, found many nurses were hired without any background or license checks.  In particular, the investigation revealed nurses who had many problems with prior jobs, caring for the sick and elderly.  

• Temp firms hired nurses with criminal backgrounds including: prostitution, stealing drugs and possession of cocaine
• Nurses who had their licenses suspended or restricted in other states were hired by temp firms
• Even after medical facilities continually complained about a nurses performance (nurses who made errors and fell asleep on the job), the nurse was placed at another facility
• Nurses who were terminated at one agency were quickly hired by another one without any questioning as to why they left the first agency

No surprise, but it always comes down to money

The lack of industry regulation, a national nursing shortage and easy profits (most temp agencies get paid a substantial percentage of the workers salary) does nothing to discourage people with no nursing or health care knowledge to the field.

Our sick and elderly deserve better.  Patients can and should expect that the person who is caring for them is more than a warm body.  Facilities must begin to demand that the full background checks be conducted on the fresh faces working in their facilities.  On a regional and national level, elected officials must propose legislation to regulate this growing industry.  Unfortunately, until these changes are made, we will continue to see preventable errors contribute to injury and death of patients. 

Resources:

Temp firms a magnet for unfit nurses, With scant regulation and some agencies' poor screening, workers can hopscotch from job to job. L.A. Times, December 6, 2009

Health Care Worker Registry, Nursing Homes Abuse Blog, June 27, 2008

Bye Bye Criminals, Nursing Homes Abuse Blog, June 1, 2008

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000, Nursing Homes Abuse Blog, June 5, 2009

The Estate of a deceased nursing home patient has filed a wrongful death lawsuit against the facility where she died and other parties who allegedly contributed to her death.  The crux of the lawsuit alleges that the staff and physicians at the nursing home failed to note the woman's allergy to medications containing Sulfonamide, a common ingredient in antibiotic medications such as Bactrim.

After the the staff at the nursing home began administering Bactrim, the woman began to experience a severe reaction on her skin.  According to the lawsuit, 

"the plaintiff's decedent sustained a severe reaction to the administration of Bactrim, D.S., she developed multiple large open areas in the skin over large portions of her body, portions of her skin sloughed off; the skin over her entire body became 'tented' and she developed red blistering over the back of her neck and back and she developed toxic epidermal necroysis, causing her skin to slough off, she lost 55% of her active skin, she had a positive Nikolsky sign, she had whole body erythema, lesions, blistering and sloughing"

The lawsuit has been filed against 17 different defendants, including Atrium Health Care and Rehabilitation Center in St. Clair County Circuit Court (Illinois).  The lawsuit seeks $1.9 million.

Toxic epidermal necroysis following the administration of Bactrim?

Sounds like this woman was suffering the effects of Stevens Johnson Syndrome.  Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction.

SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Although at least from the allegations in the complaint, this facility failed to note this woman's allergies, I'm sure they also failed to monitor the severe skin reaction and notify the woman's physician about the change in her condition. 

Read more about this wrongful death lawsuit here.

Related:

Medications Commonly Prescribed To Nursing Home Patients May Cause Stevens Johnson Syndrome

My office frequently gets contacted by concerned family members who may be unable to specify the exact type of error and facility made, but nonetheless they have a clear belief that their loved one's condition has changed for the worse due to improper care or taking an dangerous drug.  

Recently we were contacted by the family of a lady who within several months of taking Reglan Tablets, began to develop severe muscle spasms in her face.  We soon found out that the staff physician had prescribed Reglan several months before the spasms started.

Reglan (generic name – metoclopramide) speeds up the movement of the stomach muscles, which increases the rate at which the stomach empties into the intestines. This prescription drug is used to treat gastrointestinal disorders including heartburn caused by gastroesophageal reflux disorder (GERD), diabetic gastroparesis (stomach does not contract), and to prevent nausea and vomiting caused by cancer chemotherapy and surgery.

Reglan can cause serious side effects including:

• Tardive Dyskinesia - abnormal muscle movements (see “Black Box Warning” below)
• Uncontrolled spasms of your face and neck muscles, or muscles of your body, arms, and legs (dystonia)
• Depression, thoughts about suicide, and suicide
• Neuroleptic Malignant Syndrome (NMS) –
• Parkinsonism – condition similar to Parkinson’s, symptoms include slight shaking, body stiffness, trouble moving or keeping your balance

The FDA's Black Box Warning On Reglan

The FDA has recently required that manufacturers of metoclopramide add a “black box” warning about the risk of its long-term or high-dose use. The black box warning is the FDA’s strongest warning for drugs.

According to the FDA, more than 2 million Americans use drugs that contain metoclopramide (including Reglan tablets, Reglan oral disintegrating tablets, metoclopramide oral solution, and Reglan injection). Following this new warning, the FDA advises that chronic metoclopramide therapy should be avoided in all but rare cases where the benefits outweigh the risks.

Chronic use of metoclopramide has been linked to tardive dyskinesia, which may include involuntary, repetitive, and purposeless movements of the body (including grimacing, lip smacking, tongue protrusion, eye blinking, or rapid leg and arm movements). These symptoms are rarely reversible and there is no known treatment; although, in some patients, symptoms may lessen once metoclopramide treatment is stopped.

The risk of development of tardive dyskinesia is directly related to the length of time a patient is taking metoclopramide and the number of doses taken. Elderly patients are among the greatest at risk, especially older women and patients who have been on the drug for a long time. Therefore, extreme caution should be taken in prescribing Reglan to elderly nursing home residents. Your chances for getting tardive dyskinesia go up:

• The longer you take Reglan and the more Reglan you take (you should not take raglan for more than 12 weeks)
• If you are older, especially if you are a woman
• If you have diabetes

Nursing homes should immediately evaluate all residents who are currently taking Reglan in order to determine whether continued Reglan treatment is necessary and beneficial in light of the FDA warning.

If you believe that your 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

Resources:

FDA: FDA requires boxed warning and risk mitigation strategy for metoclopramide-containing drugs

National Institute of Neurological Disorders and Stroke: Tardive Dyskinesia

FDA: Reglan Medication Guide