The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don’t make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration’s action.

"People in nursing homes have a right to know how well they’re performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.

After a 2 week trial in Hendersonville, North Carolina, the jury awarded $800,000.00 to the Plaintiff. Plaintiff was represented by Poliakoff & Associates of Spartanburg, South Carolina. The jury award was $200,000.00 for personal injury suffered by the decedent while a resident at Brian Center – Hendersonville, and $600,000.00 in punitive damages. The Brian Center – Hendersonville is a nursing home owned by SSC Hendersonville Operating Company, LLC which is a subsidiary of  SavaSeniorCare. The Defendant denied all liability, and vigorously defended the entire suit.

 

The Plaintiff argued that the decedent, Neal Hawkins, Jr., was identified by the Brian Center as being high risk for falls, but that the facility did little to address this problem in the care plan for the resident, and failed to revise the care plan on occasions when changes in his condition compelled such. Further, on February 11, 2005, Mr. Hawkins fell 3 times in one day at the facility, apparently fracturing his hip on the 3rd fall. Plaintiff further argued that the nursing facility failed to properly assess the patient, failed to follow procedures, failed to follow doctor’s orders, and allowed Mr. Hawkins to remain in the facility in pain for 7 days following the fracture, until he was finally transferred to the hospital.

 

The Defendant denied that it was liable or responsible for the falls or any resulting injury, and argued that it followed appropriate procedures. On November 16, 2007, the jury awarded a total of $800,000.00 in actual and punitive damages.

 

Plaintiff’s experts were Dr. Jonathan Klein of Falls Church, Virginia; Janet White of Emporia, Virginia; and Katherine Johnson, of Orlando, Florida. The case was tried for the Plaintiff by lead counsel Gary W. Poliakoff, Raymond P. Mullman, Jr., and Lara Pettiss Harrill. Also participating were attorney Matt Yelverton and attorney Greg Newman, both of Hendersonville, North Carolina.

 

As of the time of writing of this entry, the Defendant has indicated a possibility of appeal.

 

I read a great article about the myth of frivolous lawsuits and how insurance companies have created the Stella Awards to mislead the public (and juries) about frivolous lawsuits.  If there is so many frivolous lawsuits, why does the Chamber of Commerce and the insurance industry feel the need to make up these ridiculous lawsuits?  Below is an excerpt of the article.

  Recently one of my oldest and dearest friends, a man whose Harvard Ph.D. doesn’t begin to measure his intellect and wisdom, sent out one of those mass e-mails meant to amuse and appall. "OMG! It’s even worse than we thought," his message began. It was followed by something called the annual Stella Awards, a list of the year’s seven "most outlandish lawsuits and verdicts in the U.S."

In last place was the tale of Kathleen Robertson of Austin. A jury decided a furniture store owed her $80,000 for a broken ankle she suffered tripping over a toddler running wild in the store. "The store owners were understandably surprised by the verdict, considering the running toddler was her own son," the e-mail said.

Numbers six through two are more ridiculous.

Then comes numero uno. Winnebago winner? "This year’s runaway First Place Stella Award winner was Mrs. Merv Grazinski, of Oklahoma City, who purchased a new 32-foot Winnebago motor home. On her first trip home, from an OU football game, having driven on to the freeway, she set the cruise control at 70 mph and calmly left the driver’s seat to go to the back of the Winnebago to make herself a sandwich. "Not surprisingly, the motor home left the freeway, crashed and overturned. Also not surprisingly, Mrs. Grazinski sued Winnebago for not putting in the owner’s manual that she couldn’t actually leave the driver’s seat while the cruise control was set. "The Oklahoma jury awarded her – are you sitting down? – $1,750,000 plus a new motor home. Winnebago actually changed their manuals as a result of this suit, just in case Mrs. Grazinski has any relatives who might also buy a motor home."

The e-mail concludes: "Are we, as a society, getting more stupid?" Guffaws around the world The answer may well be yes, stupid enough to believe that this sort of nonsense really happens.

 My friend was not the only credulous one. A Nexis search for the name "Merv Grazinski" turned up scores of articles, the vast majority buying the Winnebago story as gospel truth. More than a few are lazy columnists, who were too dazzled by marvelous stories to do even the easiest research to determine whether they were true.

Among outlets falling for the hoax were the New York Daily News, CNN and U.S. News & World Report. American writers weren’t alone in their gullibility. Even more credulous mentions of the daffy Mrs. Grazinski (or Mr. Grazinski in some accounts) appeared in foreign papers. Readers in Canada, England, Australia, Ireland, New Zealand and even Vietnam guffawed at the expense of us stupid Americans.

To its credit, the Austin American-Statesman debunked the story of Ms. Robertson and her toddler several years ago, when the "Stella Awards" started making the rounds. Los Angeles Times reporter Myron Levin went one better. He called Winnebago. "Wide acceptance of the myths has been an eye-opener for Sheila Davis, public relations manager for Winnebago Industries in Forest City, Iowa," he wrote. "Davis says she has repeatedly had to explain that no, there was no Grazinski lawsuit, and, no, the company did not have to change the owner’s manual to avoid a swarm of copycat claims."

 Even ones such as the notorious McDonald’s scalding coffee suit are not nearly so silly as they become in manufactured legends. The Albuquerque jury did award Stella Liebeck, 79, (after whom the "Stellas" are named) almost $3 million after she spilled coffee on her lap, causing third-degree burns, a week’s hospitalization and skin grafts. But the jury had learned that McDonald’s served its coffee much hotter than other restaurants, that it had received more than 700 previous complaints and had paid more than $500,000 in earlier settlements. Liebeck originally asked for just $20,000 to cover her medical bills and other expenses, and that McDonald’s serve its coffee at a more moderate temperature. McDonald’s offered her $800. Shortly before trial, a mediator recommended McDonald’s pay $225,000. The company said no. Jurors awarded $160,000 in damages and $2.7 million in punitives, hoping to change the company’s behavior. The judge lowered the punitives to $480,000, and the case settled for an undisclosed amount, presumably less.

Here’s the lesson: The next time an Internet tale makes you think things are even worse than you thought, check it out. Especially when the tale suggests that the American system is stacked against wealthy corporations. One easy way: www.snopes.com, an excellent site that investigates urban myths. It took less than 30 seconds to ask for "Stella Awards" and receive the verdict: "False."

A family whose mother passed away two years ago after spending just a month in a nursing home says her death should not have happened then and now they’re asking for help. "She walked, talked, could eat on her own," said Arnold Trevino, remembering his mother before she checked in," he said, "when she left out of there, she left out of there an invalid, she couldn’t talk," he explained. Full article here.

He says after his mother stayed at the Valley Grande Manor for just 30 days, the damage was done.   Trevino said his problems with Valley Grande Manor began when his sister, a registered nurse, told the staff her mother was suffering a heart attack. He claims the staff refused to take her to the hospital, so he called the state to get her out. "When she was taken to the hospital, doctors told us she had not been fed, given any water and that she had abusive bruising that they don’t know how she relieved," said Trevino.

That’s when he took pictures he says are even more proof. Natalia Trevino died just weeks later, her death certificate names malnutrition as a contributing factor.

Trevino says he’s frustrated, because even though this report shows several violations including LVN staff without a valid license, and others with convictions working there, he can’t get anyone to take action.

But Trevino wants someone to take action against the staff that treated his mother. "I want for them to face the same consequences that I would have faced if I would have taken my mother to the hospital in that condition," Trevino said.

Here is a very interesting story from a resident’s point of view.  Billy Bogardus, a retired engineer, said he received poor care while he was a patient in Haven Health Center of South Windsor earlier this year. "You had to beg and plead to get them to pay attention," he said.  Bogardus of West Hartford went into a Haven Healthcare nursing home to recuperate from a hospital stay, but ended up fighting for his life.

For four days in April, Bogardus and his close friend, Leona Brenner, tried to convince the staff of the Haven Health Center in South Windsor that he was dying. Bogardus, who had sought nursing-home care after complications from heart surgery, was coughing, struggling to breathe and couldn’t walk the six steps from his bed to the bathroom, he and Brenner said.

Only after Brenner threatened to call 911 herself did the nursing staff finally summon an ambulance, the couple recounted. By the time the 69-year-old retired civil engineer arrived at St. Francis Hospital and Medical Center in Hartford, hospital records show, he was dehydrated and his kidneys were failing.

"If it wasn’t for [Leona], I’d be dead half a dozen times," said Bogardus, who landed in the hospital several other times during his seven months in the nursing home — once when a blood test found his level of the medication Cumadin was five times higher than normal. "You had to beg and plead to get them to pay attention. I think I would’ve been better off out on the street."

Bogardus’ complaints were not new. Last year, a state inspection report detailed numerous complaints from residents about the "difficulty they have experienced in obtaining staff assistance."
The South Windsor home is one of 13 Haven Healthcare homes with staffing levels that fall below both state and national averages, according to the most recent federal data. Nationwide, nursing homes provide an average of 3.6 hours of care per resident per day — 1.3 hours by licensed or registered nurses, and 2.3 hours by certified nursing assistants. A study commissioned by the federal government recommends that each resident receive 4.1 hours of care a day.

But in Connecticut, nursing homes have had little incentive to boost staffing. The state’s minimum-staffing law, which has not been updated in more than 25 years, requires only 1.9 hours of nursing care a day per resident — less than half of what the Centers for Medicare & Medicaid Services’ study recommends.

Although the state’s public health code also requires that each facility has sufficient staff to ensure residents receive appropriate care, state public health officials have been reluctant to use that provision to penalize homes for understaffing, or to make demands on homes to add staff when deficiencies are found, records indicate.

Federal data show that Connecticut in 2006 cited only 2 percent of nursing homes, under federal rules, for failing to provide sufficient nursing staff — a lower rate than 27 other states. In 2005, its rate of citing homes for staffing deficiencies was among the lowest in the country — zero.

Haven Healthcare — which has the lowest staffing average of the state’s three largest chains, according to the most recent data — is one of many nursing home operators in Connecticut that stand to benefit from those policies. But it also provides some compelling examples of the consequences.

Many of Haven’s 15 homes in Connecticut have been cited in the last three years for bed sores and dehydration — two key indicators of understaffing, according to federal health officials and nursing home experts. In February, the chain’s Waterford home was hit with the largest penalty imposed by the state in three years — a $100,000 fine and two years’ probation — for neglecting a sore on a resident’s heel for so long that his leg had to be amputated, in addition to other violations.

But in most cases where Haven has been cited for bedsores or dehydration, state officials have not mandated any increase in staffing. Even in the Waterford case and two other Haven cases that triggered "consent orders" by the health department — the highest level of enforcement — the department did not require increases in staffing ratios.

In a number of cases where serious patient-care deficiencies have been found in Haven homes, follow-up state monitoring often consists of the assertion: "Staffing was reviewed and found to be in compliance with the minimum staffing levels of the public health code" — a certification that nursing home advocates say is meaningless.

Jennifer Keyes-Smith, an advocate for the elderly who formerly worked for the state as a regional nursing home ombudsman, complained in a letter last winter to the attorney general’s office that she had tried repeatedly several years ago to get the ombudsman’s office and the state Department of Public Health to address chronic understaffing at Haven’s New Haven home — without success.

"I continued to visit the facility and observed resident call bells going unanswered, residents not being fed, residents not being toileted, and staff treating residents disrespectfully," she wrote last November. "With basic human needs not being met, I continually urged the program’s prompt intervention and DPH’s expedient response. I was then told to stop working on the case."

Haven Healthcare CEO Raymond said he could not recall the state ever punishing the chain for understaffing or mandating higher staffing ratios.

Last week, state Attorney General Richard Blumenthal disclosed that state and federal officials were investigating whether Haven Eldercare, the chain’s parent company, improperly diverted government funds away from patient care. Termini said the company’s financial issues never impacted the level of care.

Read More →

This story really upset me.  I can’t imagine the excuses the nursing home will use to explain this neglect away.  Florida police began investigating why an 82-year-old man from the University Center West nursing home was so severely neglected, he ended up in the hospital.

The man was taken to the hospital suffering chest pains and difficulty breathing.  What doctors found was so alarming, they had to call DeLand police.

Doctors told police the hospice patient had bed sores, his breathing tube was infected, and they found maggots in his left eye.

JoAnn Grasso, the administrator of the nursing home, declined to comment specifically on the case.

Former University Center West employee Monique Miller said she was not surprised.

"I haven’t seen maggots — but bed sores, yes," Miller said. "That doesn’t surprise me at University Center West. No, it does not, because I’ve seen it several times."

Miller said supervisors at the home are lax and allow unhealthy conditions to continue until its too late.

"You have to be half dead for them to send you out to the hospital, because they’re afraid to lose money, or their beds will be empty," Miller said. "That’s scary. It’s very scary. You have to watch it. You have to be very careful when you put a family member in a nursing home — all nursing homes."

A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress but has yet to be passed. Although nursing home and elder abuse are serious and growing problems, the nursing home abuse bill has never even been voted on. While no one in Congress opposes the nursing home abuse legislation, few are trying to push it through the legislative process.

But the issue of nursing home abuse should be getting more attention, just based on the shear numbers of elderly affected by this crime. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse.

According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well. 

The Elder Justice Act would set up separate elderly justice offices in the U.S. Departments of Justice and Health and Human Services, provide $400 million for state adult protective services over four years and create a federal coordinating committee among agencies to monitor and direct the government’s efforts. The bill would also establish forensic centers around the country to probe elderly abuse cases and give local prosecutors more support in bringing cases. And it would penalize nursing homes if they did not report crimes swiftly. 

Staffing became an issue in the recent Kentucky Governor’s race.  Democrat Steve Beshear said that Kentucky needs to consider requiring minimum staffing levels at nursing homes, but Gov. Ernie Fletcher said the corporate owners should be allowed to determine how many nurses they hire.

Last night, Beshear said Fletcher’s administration has failed to protect seniors, citing a news story that indicated the number of citations for nursing homes has declined since the Republican became governor in 2003.

"We don’t have enough inspectors to go and enforce" laws that apply to nursing homes, said Beshear, a Democrat.

"I think it’s time to look at minimum staffing numbers," he said. "We’ve got to make sure the profit motive doesn’t interfere with the care motive."

Fletcher said the state doesn’t need to set minimum numbers of nurses for nursing homes saying that the state can ensure adequate care in other ways.

"We’ve closed nursing homes that needed to be closed," he said.

See article here.

A couple of weeks ago there was a  nursing home trial over in Tallulah, Louisiana. Tallulah is a small town about 20 miles west of Vicksburg, MS.

After a five-day trial, on Friday, November 2, 2007, a 12-person jury found that the nursing home committed medical malpractice and awarded the plaintiff $250,000 in survival damages and $500,000 in wrongful death damages. The jury also found that the nursing home was negligent in failing to clean Mr. Nelms of his own waste, and awarded the plaintiff an additional $250,000 on that basis.

The lawsuit was styled Everline King, Individually and on behalf of the Estate of Leon Nelms v. Brown Development, Inc. d/b/a Olive Branch Senior Care and D. Brown Enterprises, Inc., Case No. 05-348.

In the two months preceding his nursing home stay, Mr. Nelms lived in his daughter’s home without suffering any significant injuries or complications attributable to his declining health condition. Twenty-six days after entering Olive Branch Senior Care, however, he had to be transferred to a local hospital due to Stage IV infected pressure sores, weight loss, malnutrition, and dehydration. He died six days later as a result of his infected pressure sores, one of which was so advanced that it went to the bone and was infected with his own feces. Mr. Nelms was 84 years old at the time of his death.

Resident’s family obtained a $3 million verdict against a regional nursing home operator named Sharo Shirshekan in Missouri.   The case involved pressue ulcers on both heels of the resident.  The feet had to be amputated because of the neglect.  Defendants attempted to blame the resident’s pre-exisiting conditions including peripheral vascular disease.  However, the jury realized that PVD does not cause pressure ulcers, neglect does.

 The jury returned $500,000 in actual damages for pain and suffering in the first stage and then $2.5 million in punitive damages against Mr. Shirshekan and his operating company in the second stage.