Nursing Homes Abuse Blog - By Jonathan Rosenfeld

I really applaud Illinois Attorney General Lisa Madigan's efforts to improve the safety of patients in nursing homes throughout the state.  Her "Operation Guardian" uses multi-disciplinary teams from various state and local agencies to conduct unannounced sweeps at facilities thought to care for people with outstanding arrest warrants.

To date, the operation has conducted 21 unannounced sweeps of Illinois nursing homes that has resulted in the identification of more than 100 nursing home patients with active arrest warrants.  In some situations, the people we not arrested due to the fact that they may have suffered physical or mental impairments that made their arrests unreasonable.

As reported by the Chicago Tribune, the most recent sting operation took place days ago at Central Nursing & Rehabilitation Center on the Northwest side of Chicago.  The crackdown resulted in the arrest of four patients with various criminal pasts.

Yet the fact remains that some potentially dangerous people were arrested from nursing homes where they lived freely amongst especially vulnerable people.

As I have said before, I firmly believe that the more attention that gets heaped on the safety issues facing patients in nursing homes is for the best.  But, my real question is,

Why do skilled nursing facilities continually allow criminals to live freely amongst the most vulnerable people in the first place?

I assume members of Operation Guardian have access to databases where they are able to access information regarding open arrest warrants?  Why not give nursing homes access to these databases and allow them to conduct their own review of patients in their facilities?

Further, until there are severe penalties on the books to encourage facilities to rid themselves of the bad seeds, there is little incentive for facilities to do their own house cleaning.

Related Nursing Homes Abuse Blog Entries:

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

Illinois Attorney General Continues To Keep Nursing Homes On Their Tippy Toes With Spot Raids

Attorney General Hunts Down Drug Dealing Nursing Home Patient During Raid

IL Attorney General Nabs Two Patients From An Alden Nursing Home With Criminal Warrants

Lots and lots of discussion about the $677 million verdict against Skilled Healthcare Group for not supplying that mandatory staffing levels that the State of California mandates.  Some argue that the verdict is a prime example of a jury system that's out of control, while others claiming that the large verdict is simply what the company deserves given its staffing obligations under the law. 

Like many legal developments, once the smoke clears after the initial explosion we can see that there is a lot more to the verdict than we initially thought.

Despite the initial 'sticker shock' of the verdict, the actual amount Skilled will pay the plaintiffs is substantially less.  In fact, the parties have agreed to settle the case -- to avoid bankruptcy proceedings and likely appellate hurdles-- for $50 million-- a sizable, yet substantially smaller amount than the initial verdict.

In addition to the monetary payment, the settlement also calls for a third-party to monitor the staffing levels at all Skilled Healthcare facilities for the next two years to make sure they are in compliance with their obligations under California law. 

What is the impact of the settlement on the nursing home industry?

I think its still too early to say with certainty what impact this settlement will have on the nursing home industry in general.  However, as a nursing home lawyer who represents many people who have suffered abuse or severe neglect due to inadequate and poorly trained staff, I feel that the more attention that gets focused on the industry, the better off patients will be when it comes to the type of care they deserve.

To an industry that tends to eek out profits by boosting capacity and cutting costs, I hope that-- at the very least-- the Skilled Healthcare verdict will cause them to pause and reflect on the way that they do business given the real chance of severe repercussions.  Time will only tell.

Related:

Nursing Home Operator: Settlement Stems Tumult, Orange County Business Journal, September 19, 2010

Nursing Home Chain Hit With Landmark Verdict In Under-Staffing Class Action Lawsuit

Class Action Lawsuit Against Skilled Healthcare Seeks Damages For Chronic Under-staffing Of Nursing Homes

Big Verdicts Against Nursing Homes

A Minnesota nursing home has been cited by the state's Department of Health after investigators determined that staff at the facility failed to provide prescription medication to a patient who was admitted to the facility for short-term rehabilitation.  

The investigation was triggered in response to a complaint following the stroke-related death of an elderly woman who was admitted to Lakeshore, Inc. for short-term rehabilitation.  The woman was admitted to the nursing home in order to gain enough strength so she could return back to the assisted living facility where she lived.

Despite the fact that that the facility knew the woman had a history of strokes and was prescribed Coumadin for approximately 10 years prior, staff at Lakeshore never administered the Coumadin, nor did they administer the necessary blood tests to test the drugs effectiveness.

Health Department officials elected to cite the nursing home for failing to provide the necessary medication, but elected not to impose any fines primarily because the facility voluntarily changed its policies regarding administration of prescriptions prior to any strong-arming on the part of the state.

Situations such as this provide a reminder of the importance of reporting suspected errors to the Department of Health following a suspicious event.  In this case, officials were able to examine the patients medical chart and determine where the facility went awry.  While it may disappoint some that no fine was imposed, the fact that this incident was made public should hopefully provide enough motivation for the facility to change its ways.

Related:

Nursing home found at fault after woman dies, Duluth News Tribune, September 16, 2010

Medication Errors, Nursing Home Injury Laws

Fixed Minidose Warfarin and Aspirin Alone and in Combination vs Adjusted-Dose Warfarin for Stroke Prevention in Atrial Fibrillation (PDF) by Annette Lemche Gulløv, MD; Birgitte Gade Koefoed, MD; Palle Petersen, MD, DMSc; Trine Sander Pedersen, MD; Ellen Damgaard Andersen, MD; John Godtfredsen, MD, DMSc; Gudrun Boysen, MD, DMSc, Archives of Internal Medicine

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls Nursing Homes Abuse Blog, November 30, 2009

If you're looking for another prime example of nursing home neglect, you need look no farther than to take a look at a news story in The Palm Beach Post regarding an elderly patient at Gainesville Health Care Center, a Florida nursing home. 

After losing an eye to cancer, the patient was admitted to Gainesville for medical care that included changing the dressings covering the eye socket. 

Despite physician orders to change the dressings twice daily, staff apparently failed to do so claiming that that patient wouldn't cooperate.  During an examination at a Veterans Administration facility, following a stay at Gainesville, staff discovered that the man's eye had become infected and maggots were also found in the empty socket. 

The situation was so severe, Veterans Administration authorities filed a report with the Adult Protective Services unit of the Florida Department of Children and Families who confirmed the mistreatment.  Despite the patient's refusals to allow staff to change his dressings, the facility never notified the man's physician or family.

A Facilities Duty to Provide Care vs. A Patient's Wishes

As a nursing home lawyer, I frequently see situations where facilities fail to provide medical care due to the fact that the patient is refusing such care.  In situations where a patient truly does not want the medical treatment prescribed, nursing homes still must notify the patient's physician and family of the situation.

In situations where the patient's lacks the capacity to make such decisions, staff should notify the patient's power of attorney and determine how they wish to proceed.  Failure to contact the patient's power of attorney in these situations certainly exposes facilities to liability for failing to follow the patient's care plan.

Related Nursing Homes Abuse Blog Entries:

Lawsuit Against Nursing Home Alleges Maggot Infestation Contributed To Patient's Death

Nursing Home Cleared Of Neglect Charges In Case Where Resident Had Maggots In His Eyes

Nursing Home Injury Laws: Florida

"A fall for someone who is 91 and fail, it really ends her quality of life"

Mindy Greiling, a caring daughter and state representative in Minnesota, sums it up best when describing the spiral of events that her mother experienced following a fall at the Samaritan Bethany.  Until you witness the first-hand decline patients experience following a fall, it can be difficult to relate to the experiences gone through by both patients and their families.  

Unlike falls in younger people, elderly people involved in 'minor' falls can experience devastating consequences from both a physical and psychological point of view.  Perhaps most frustrating in these cases is the fact that many of these falls contribute to a patient's loss of will to live.  

In the case of Ms. Greiling's mother, a momentary lapse in judgment by a nurses aid contributed to a fall and subsequent injuries including a fractured back and closed head injuries.  After a hospitalization for treatment for her injuries, Ms. Greilings mother succumb to her injuries just a couple of months later.

The Post-Bulletin had an insightful article about the struggles Ms. Greiling experienced following her mother's death including her experience with an investigation into the incident performed by the state department of health.  

You can take a look at the article with the link abuse, but I thought one of the more interesting aspects of the article was the fact that state investigators cited the nurses aide responsible for caring for the elderly woman for neglect, but not on the part of the facility.

To me, this was particularly frustrating as I have a difficult time understanding how the negligence of a nurses aide / nursing home employee is not attributable to facility itself?  

Either way, in situations fall-related claims against a nursing facility can actually be more difficult to prosecute when the staff member is present for the incident.  In these cases, facilities tend to argue (sometimes successfully) that the negligence on the part of the employee was isolated and certainly not a reflection of a systematic problem.  Probably true.  However, I'm sure such justification does little to ease the frustration of a grieving family.

Related Nursing Home Abuse Blog Entries:

Determining The Type Of Fracture A Person Has Sustained Can Reveal If Nursing Home Abuse Is Responsible

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

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

Results From the National Osteoporosis Risk Low Bone Mineral Density in Postmenopausal Women: Identification and Fracture Outcomes of Undiagnosed Assessment (pdf) The Journal of the American Medical Association (2001)

Perhaps you've noticed?  We've done some major re-configuring here at the Nursing Homes Abuse Blog.  Of course, all of my original entries will remain, but the site has been reconfigured to make navigation easier both on the blog itself as well as on our sister sites: Nursing Home Injury Laws and Bed Sore FAQ. 

The most noticeable feature includes links to individual state resources for laws, support agencies as well as related blog entries pertaining to the state.  The response has been extremely positive, but as always I welcome additional suggestions to improve both the layout and content of my blog.  Thanks!

Is there a major problem related to patient abuse at Springside Nursing Home?

Not surprisingly, it depends who you ask.  In my eye, I suspect the answer is a resounding 'yes' after abusive events have come to light that most definitely make me question patient care at that facility.  According to an article in the Berkshire Eagle, "Elderly patient abuse alleged" three employees at Springside have recently been terminated by the facility for their roles related to patient abuse. 

The three recently terminated employees include:

• Jodi LeBrake, for allegedly stuffing a sock in the mouth of a disabled 72-year old patient who was crying for help from the staff after she had wet herself.

• Amy Simkewicz, a CNA who witnessed Ms. leBrake's abusive conduct, but never reported the abuse to authorities

• Sandra Yankey, who incidentally has a prior criminal record, was terminated on the spot after colleagues witnessed her pulling the hair of an 80-year-old patient

Perhaps, not surprisingly, a spokeswoman for Genesis Healthcare (the parent company of Springside) Jeanne Moore said the incidents were "isolated and unrelated".  Hmmm... isolated? unrelated?

If my family were at this facility Ms. Moore's comments would hardly be soothing my concerns about my relatives safety.  Simply by the fact that these incidents occurred within a tight window of time, my suspicion is that a culture of abusive employee conduct was allowed to permeate this facility.  I certainly hope Genesis officials begin their inquest with the supervisors of these women and learn what--if anything-- they knew about this abusive conduct.

Related Nursing Homes Abuse Blog Entries:

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

Thankfully, We Now Have Many Laws To Protect The Elderly From Abuse In A Variety Of Settings. However, Laws Are Worthless, If The People For Whom They Are Intended To Help Are Unaware Of Them

Steps To Take When Filing A Nursing Home Complaint With A State Agency

Attorney Jonathan Rosenfeld Discusses Nursing Home Violence In AARP Article

When nursing homes take simple, preventative steps such as: turning patients, keeping them clean, and providing adequate nutrition and hydration; they can greatly decrease the incidence of pressure sores at their facilities.  However, even though the preventative steps are well known, many nursing facilities simply fail to implement the necessary care that patients require to function optimally.

I was particularly disturbed when I came across an article in the Arizona Daily Star regarding a Kindred-owned nursing home that has been repeatedly failed to provide sufficient wound care for its patients.  In fact, Villa Campana Health Care Center was most recently fined by state authorities $10,000 following a horrific chain of events involving a patient who was admitted to the facility last fall.

Within a month of entering Villa Campana, a patient developed a pressure sore on their buttocks.  Despite the staff's documentation of the wound, little care was provided at the wound progressed to the point that bone was involved and an infection known as osteomyelitis ensued.  Eventually, the patient required multiple surgeries to treat the advanced pressure sore including a debridement surgery to remove portions of the coccyx, sacrum and surrounding tissue.

The most recent fine follows other violations at the facility including:

• A 28 day suspension on new admissions to the facility implemented by Medicare
• In September, 2009 the facility was fined $68,000 for non-compliance with applicable regulations
• In December, 2009 Arizona officials fined Villa Campana $11,525 for the violation of 33 state rules pertaining to the monitoring and treatment of patients' pressure sores

Government officials have picked up on Villa Compana's deficiencies and have categorized the facility in the one-star category-- the lowest rating according to Medicare's, Nursing Home Compare site.  Similarly, the Arizona Department of Health Rates Villa Campana as 'D' in quality-- the state lowest rating for nursing homes.

Certainly, the fact that this Kindred facility has such an extensive history regarding the inadequate prevention of patient's pressure sores should give rise for concern.  Pressure sores and osteomyelitis are prime examples of nursing home negligence and commonly give rise to lawsuits against the facility where the wound developed.  A lawsuit for the development of a pressure sore can recover damages for medical expenses and the pain that accompany the wounds.

Related Nursing Homes Abuse Blog Entries:

Arizona Nursing Home Fined For Multiple Safety Violations

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

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

Bed Sore FAQ

Many facilities offer multiple levels of care depending on the needs of the patient: skilled nursing care, assisted living and independent living options.  The variety of services can be great for patients who may desire to remain at a facility for an extended period of time.  If, and when, the patient requires more assistance they can simply move from one area to another with a fair amount of continuity.

It should go without saying that even the most independent patients at these one-stop-shop facilities are still dependent on staff and their colleagues for some assistance and support.  Even folks living in an independent living environment are there because they can not or choose not to live in their true homes.

The Journal Sentinel reported on situation at a Milwaukee independent living facility that highlights the problems encountered by an injured patient at the facility.  Like many independent living facilities, Clement Manor has multiple levels of care for patients depending upon their needs.

However, even the 'independent living' apartments are equipped with pull-cords that a resident can use to contact staff for assistance in an emergency situation.  Implicitly, by having the pull-cord in the patients room, there is an understanding that staff can-- and will, attend to patient needs when they are notified.

A lawsuit filed against Clement Manor and its sponsoring entities School Sisters  of St. Francis and School Sisters of St. Clare alleges staff at the Clement Manor facility acted 'inexcusably and unconsciously' when they ignored a patients call for help --- for more than four hours.  The delay in response to the patients injury is alleged to have contributed to the patients death due to her uncontrolled bleeding.

An investigation into the incident by local police determined that the patient's pull cord was activated at 12:25 a.m on February 15th after the patient somehow cut a varicose vein.  Despite a visual and audible alarm at the attendants station, no assistance was provided until 4:34 a.m. when the patient was found dead in her bathroom from uncontrolled bleeding.

Independent Living Facilities & Lack of Regulation

If the patient's family can establish that this independent living facility  acted negligently in responding to the patient's request for help, a jury will then asses damages against the facility.  However, this situation may be more difficult that you would think given the fact that there really is no regulation-- and really no formal 'standard of care' for this patients family to base their claims on.

Certainly, as our population ages and as more and more living arrangements are introduced, we need to impose standards to help protect those who may be unaware that they really are testing uncharted waters.

Related Nursing Homes Abuse Blog Entries:

Are Group Homes A Viable Alternative To Nursing Homes?

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

Call Lights. How Should Staff Respond?

Perhaps someone should have advised Angela Almore, a nurse at Britthaven in Chapel Hill, NC, that physicians are the only ones capable of prescribing prescription medications for patients. 

Seemingly taking the practice of medicine into her own hands when she administered Morphine to patients who should not be taking it; Ms. Almore now faces one count of second-degree murder and six counts of felony-patient-abuse after the death of one patient and the hospitalization of six others she was responsible for caring for in the Alzheimer's unit at the facility.

An investigation into the incident by the Nursing Home Licensure Section revealed that in addition to the errors made by Ms. Almore, the Britthaven facility  was also negligent for failing to take the necessary steps to ensure that its patients were protected from abuse. 

As a result of the facilities errors, state regulators have requested that the Centers for Medicare and Medicaide Services (CMS) impose a $20,000 fine against the facility. 

Medication Overdoses Amongst Nursing Home Patients:

Medication errors, such as overdoses are a common problem in nursing homes-- particularly amongst disabled patients who do not have the ability to confirm the types or dosages of medications they may be taking.  Unfortunately, aside from lacking the ability to confirm or deny the medications they are to be taking, disabled patients are especially fragile when it comes to potential side effects from the drugs.

Opiates, such as Morphine can be especially dangerous in frail people or those who may be taking other medications that may essentially make the medications more potent than they may be on their own.  In some situations, the ingestion of high dosages of morphine can essentially shut down the bodies central nervous system making the body forget basic functions such as breathing.

If you believe your loved one was give an overdose of Morphine, it is important to seek medical attention immediately by contacting 911 or the National Poison Control Center at 1-800-222-1222.

Related:

Morphine Overdose: Medline Plus

Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone) Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, Kress HG, Langford R, Likar R, Raffa RB, Sacerdote P.

Nursing Home Faces Fines For Medication Violations WCHL News, August 11, 2010

Lawsuit Filed Against Nurse Who Intentionally Gave Too Much Morphine

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

I was frankly disturbed when I came across an article in the Press-Citizen by Clark Kauffman regarding a director of nursing at an Iowa nursing home who obviously bullied her employees into keeping quiet regarding poor care they may have witnessed at the facility.

Karen Etter, the former director of nursing at Windmill Manor Nursing Home, was charged with attempting to impede or interfere with state inspections at the nursing home she was responsible for overseeing.  Despite Ms. Etter's admission that she told employees at the facility that they would be fired if they reported dangerous conditions to state nursing home inspectors as opposed to herself or other administrators at the facility-- she was acquitted of the charges.

The judicial magistrate that determined Ms. Etter should be acquitted based its conclusion on the fact that the comments were not applicable to an immediate investigation that the state was conducting as was seemingly the intention of the law. 

Not surprisingly, Windmill Manor has a history of violations related to health and safety violations and is facing $92,400 in state and federal fines related to the pattern of poor care. 

As far as I am aware, Iowa is one of only a few states that makes the interference of a nursing home inspection a crime.  Under the terms of the 1957 law, officials can impose fines or criminal prosecution in cases where an individual or company interferes with the inspection.

Although this particular nursing home employee may have evaded criminal charges, I admire Iowa legislators for having the foresight to create such a law.  Unfortunately too many nursing home employees knowingly disrupt or interfere with investigations at their facilities out of perhaps fear of personal liability or fallout from the facility administration.  I hope other states legislate to assure nursing home investigators can do their job.

Related:

Iowa Nursing Home Cited For Inadequate Care Of Pressure Sores

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Your Nursing Home Has Likely Been Cited For Violations

Nursing Home Inspectors To Seek New Jobs Following Discovery Of Dangerous Living Conditions