The Wall St. Journal reported the arrest of Jennifer Robinson who was Social Services Director at a Queens nursing home is charged with stealing about $220,000 from an elderly patient who suffered from dementia.  Robinson was arraigned on charges of grand larceny and falsifying business records. Robinson allegedly wrote checks and withdrew funds from Walter Witko’s bank account. She’s also accused of posing as his niece and having him transferred to a different nursing home after a hospital stay.  Witko died last July. Bail was only $15,000 

By Linda Shrieves, Orlando Sentinel

For the past two decades, state medical boards responsible for disciplining doctors have failed to punish more than half of those whose hospitals revoked or restricted their privileges, according to a new report released Tuesday.

And in Florida, the proportion was higher than the national average. The study, conducted by the nonprofit consumer advocacy group Public Citizen, found that 63 percent of the doctors whose hospital privileges were restricted or revoked were not disciplined by the state’s Board of Medicine.

Altogether, the report says, 32 states let more than half of the offending doctors go without any reprimand.

"One of two things is happening, and either is alarming," said Dr. Sidney Wolfe, an internist and director of Public Citizen’s Health Research Group and overseer of the study. "Either state medical boards are receiving this disturbing information from hospitals but not acting upon it or, much less likely, they are not receiving the information at all. Something is broken and needs to be fixed."

At the Florida Department of Health — which oversees the state’s Board of Medicine — a spokeswoman said they were still reviewing the Public Citizen report. The Sentinel tried to contact several members of the board for comment, but got no answer or no response.

The report, which was based on data from the National Practitioner Data Bank from 1990 to 2009, examines the number of doctors whose hospitals barred — or put restrictions on — them practicing medicine there.

Of the 10,672 U.S. physicians who faced hospital sanctions, 55 percent escaped any licensing action or discipline from their state medical board.

The National Practitioner Data Bank, which began operating in 1990, was designed to stop the movement of "problem practitioners" from one hospital or one state to another. Licensing boards are required to report all actions that revoke, suspend or restrict a license for reasons related to the practitioner’s professional competence or conduct.

In addition, professional societies must report all professional review actions that affect the membership of a physician or dentist. Hospital administrators must report disciplinary actions that negatively affect a doctor’s clinical privileges for more than 30 days and must refer to the Data Bank when appointing or reappointing medical and dental staff.

Malpractice insurance carriers also are required to report all settlements against physicians, dentists and other licensed health-care providers. The information is available to state licensing boards; hospitals and other health care organizations; professional societies; some federal agencies; and plaintiffs’ attorneys in a malpractice suit.

"In 20 years, only 10,000 doctors have ever been disciplined — which is an indictment of hospitals," Wolfe said. "But once hospitals take action, it’s pretty serious. Of those, 5,800 were thrown off the staff of the hospital."

Yet in many cases, Wolfe said, the state medical board did not discipline the doctor any further. And many of those doctors are still practicing medicine, he added.

"It’s a real indictment of medical boards," Wolfe said, because these cases are the most egregious and already have been investigated by the hospital. "It’s like handing you a case on a silver platter. The investigation has been done."

In Florida, the governor’s office selects the 15 volunteer members of the Board of Medicine. In addition to 12 doctors, the board includes three consumer members.

Patient advocates say the report is troubling.

"I wonder how many [of these doctors] are repeat offenders," said Josephine Mercado, executive director of Hispanic Health Initiatives, a Casselberry nonprofit and patient advocate for the Hispanic, Haitian and Vietnamese communities.

Wolfe’s staff found that one Florida doctor had hospital privileges permanently revoked in 2002 for incompetence and racked up 10 medical malpractice reports totaling $1 million between 1992 and 2009. Those mistakes included performing an unnecessary procedure, leaving a foreign object in a patient and misdiagnosis. Two patients died, but Wolfe and his staff say that the state of Florida took no disciplinary action against the doctor.

Wolfe said he can’t name the doctor because the database doesn’t provide the public with access to physicians’ names.

In Illinois, a doctor had clinical privileges permanently revoked in 1999 and accumulated 10 medical malpractice reports between 1992 and 2006 totaling $7 million. Those errors included improperly managing cases, failing to diagnose and failing to identify fetal distress. One patient suffered a major permanent injury while another became a quadriplegic due to a brain injury. Public Citizen said Illinois did not discipline the doctor.

Other highlights from the report are:

•Of the 5,887 physicians who the state medical boards failed to discipline — many of whom also had a history of medical malpractice payments — 1,119 were disciplined for incompetence, negligence or malpractice; 605 were disciplined for substandard care; and 220 were identified as an immediate threat to health or safety.

•Other categories of serious deviations of physician behavior and/or performance that resulted in the loss of hospital privileges included sexual misconduct; inability to practice safely; fraud including insurance fraud, fraud obtaining a license and fraud against health care programs; and narcotics violations. A total of 2,071 physicians were disciplined by their hospital employers for one or more of these violations.

•3,218 physicians in the study lost their clinical privileges permanently, and an additional 389 physicians lost privileges for more than one year.

lshrieves@tribune.com or 407-420-5433

 

I see so many articles about nursing home employees being arrested or convicted for physical and sexual abuse.  It is very disheartening.  Part of the problem is that most states allow convicted felons to work in nursing homes and most nursing homes will hire any warm body instead of properly interviewing and evaluating their employees.  Here are some examples:

See article from Danvers Herald. Nancy Aiguobargueghian was a certified nursing assistant (CNA) assigned to the Hunt Nursing and Retirement Home in Danvers.  She was initially investigated by the Massachusetts Department of Public Health regarding an assault on an elderly resident under her care.  After the DPH looked into the matter, the case was referred to the Attorney General’s Office for prosecution.

She was later convicted by a Salem District Court jury of assault and battery on an elderly person at the Hunt Nursing and Retirement Home in Danvers in 2006. In July 2006, Aiguobargueghian was assigned to provide care to the victim, and physically assaulted the victim while the patient was in a wheelchair. The assault was witnessed by nursing home employees.   Aiguobargueghian was sentenced to serve two years of supervised probation with conditions that she complete an anger management course and that she provide no direct patient care during the period of probation.______________________________________________________

NineMSN reported the story of nursing home staff being fired after photographing residents naked and depriving a man of food. The workers were found to be negligent in their care of residents and would take part in a game called the "Genital Friday Club".   The "Genital Friday Club" involved photographing the genitals of the residents on an iPhone and then passing the images around for colleagues to guess who they belonged to. Two nurses were fired after an independent investigation into staff conduct at Central Coast’s William Cape Gardens nursing home.  It was alleged three nurses had told an elderly woman with dementia that her husband was having an affair with her best friend while she was in care. In another incident, when an elderly resident was deprived of food, one nurse allegedly said: "He was going to die anyway and this way it would make it quicker."

Most disturbing, the acts of neglect and abuse were "known by quite a few members of staff" and were committed over a period of "some months".____________________________

The San Jose Mercury News reported the arrest of three nursing home workers in Sunnyvale on suspicion of elder abuse, after authorities allege one of the assistants yanked on an elderly man’s genitalia, and two other employees who knew did nothing about it.

Arnold Samson was a certified nursing assistant who worked at Idylwood Care Center. He faces charges of committing elder abuse and battery against a resident of a skilled nursing home in January.  Ryan Tan and Ricardo Martinez allegedly had knowledge of the abuse and not reporting it, as mandated by law.

While questioning the resident about who was touching him, the employee saw Samson approach the elderly man, grab his genitalia, and make a crude comment. Follow-up interviews by agents revealed that Samson had been seen grabbing and pulling on this man’s genitalia on other occasions, and threatening to touch him "in an attempt to torment him."

 

Texas’ state budget would close 50 percent of the state’s nursing homes and leave 43,700 elderly and disabled people without a facility.  Republicans are vowing to cut spending on the elderly and vulnerable in order to balance the budget.  One recent proposal would cut state Medicaid spending by 33 percent. The elderly and disabled take up 59 percent of Medicaid spending in Texas and much of it goes to nursing homes.

In addition to the elderly and disabled who would lose their facilities, nursing homes would lay-off 60,000 workers.

Meanwhile State Rep. Jose Menendez is pushing the Department of Protective and Regulatory Services to add a 24/7 hotline for elderly residents of nursing homes and critical-care centers. If the bill is passed, anyone in those facilities could have access to immediate help — whether they’re reporting abuse or they need an ambulance.

Here is a letter to the editor from Travis Duffley:

I am appalled by the Texas Legislature’s lack of concern for our elderly citizens who live in Texas nursing homes.

As both a nurse who works in a local nursing home and as a taxpaying citizen, I understand the need to balance our Texas budget, and I applaud our elected officials’ attempts to do so without raising taxes, but cutting Medicaid funding to nursing homes is not the way to accomplish this.

Texas ranks 49th on its reimbursement rates to its nursing homes. Now our Legislature is considering cutting the Medicaid rates to nursing homes by 33 percent.

Being a proud Texan, I guess if we can’t be first, we should be last, because that is where we will end up with these cuts, and with the resulting decline in care to the elderly in our state. I encourage San Angeloans to contact their elected state officials and stand up for those who cannot defend themselves.

 

 

Florida’s WPBF.com reported the arrest of Steven Ferrelli accused of fondling a disabled woman at a Palm City Nursing and Rehab Center. The wheelchair bound victim told detectives that Ferrelli entered her room and sat on the bed with her, putting his arm around and kissing her on the lips.  Ferrelli chased her into the bathroom and startled to fondle her.

According to the arrest report, Ferrelli ran off after a nurse walked in and caught him with his pants down. Deputies said he was later caught in the woods behind a shopping center. Detectives said Ferrelli was at the nursing home with his girlfriend and a child to visit a family member.

Why was he allowed to go into her room?  Where was the staff when this was going on?

Nursing homes are required to properly assess residents.  A big part of that ongoing assessment is documentation.  The latest version of the Minimum Data Set is very detailed.   The form has to be filled out upon admission and periodically during the resident’s stay, and again upon the resident’s discharge. This has added to the workload of overstressed and underpaid staff at the typical nursing home but it is essential for quality care. 

The questionnaire requires several hours to fill out, in part because it requires nurses to interview residents at length. Medicare use the questionnaire to set reimbursements to nursing home operators, and state regulators use it to check on the facility’s quality of care.

One of the authors of the form was surprised to discover how little experience even the best staff members had in probing the patients’ needs one-to-one.

"It was very revealing to me that they weren’t doing the interviews because of the time pressures that are currently in nursing homes to get the meds passed and the vital signs checked, that the kind of fundamental assessment that needs to be done was getting short shrift."

The Centers for Medicare and Medicaid Services offered training materials including videos demonstrating patient-interviewing techniques for sections in the questionnaire such as mood, cognition, pain, preferences.  Turnover among residents is much greater now than it was when the first questionnaire was developed more than a decade ago.

See L.A. Times article here.

WSPA reported that Michael Morgan was arrested on two counts of first degree assault and battery for fondling two residents at Magnolia Manor in Greenville.  Police say this isn’t the first time the nursing home has had the same kind of complaints about the same man.  "News Channel 7 also learned that residents complained of the same types of assaults several weeks ago, and a police report was filed then. Investigators say the suspect description matched that of Morgan."  He has now been accused of molesting five people at Magnolia Manor.  Greenville police say there were three female and two male victims of the attacks March 17 and Feb. 25.

Magnolia Manor is owned by Fundamental Long Term Care Holdings LLC out of Sparks, Md.   The facility has contracts with Fundamental Administrative Services LLC and Fundamental Clinical Consulting LLC which are also owned by Fundamental Long Term Care Holdings LLC.  Fundamental is owned by Murray Forman and Leonard Grunstein.

No one knows how the man got into the nursing home undetected or why the residents were not being supervised to prevent the assault.   Sgt. Jason Rampey says Morgan worked for a company that provides services to nursing homes. 

 

Consumer advocates and industry experts are calling for an investigation into Republican Gov. Rick Scott’s  dismissal of Florida Ombudsman Brian Lee claiming that the governor’s “interference” was illegal.  Federal and state laws prohibit political interference with and retaliation against the ombudsman.  Lee, who had held the post for seven years, previously worked under Republican Govs. Jeb Bush and Charlie Crist and was a champion of residents’ rights.

The last straw, Lee believes, was his Jan. 31 letter to nursing homes directing them to submit information on their ownership, as permitted under the new federal health care legislation. It’s a contentious issue in the industry; critics say that’s because facilities are often broken into multiple businesses to make lawsuits against them more difficult.   After Lee’s departure, a new letter was sent out to nursing homes telling them to disregard the order.

“This is really a disaster for the residents of Florida nursing homes,” said Kate Ricks, chair of Voices for Quality Care, a Maryland-based nonprofit that supports patients’ rights.  “There are problems in nursing homes and assisted-living facilities across the country, and there are very few resources to help — but the ombudsman is one. The ombudsman’s only job is to be an advocate for those residents. He has to be independent.”

The federal Administration on Aging sent a letter to Voices for Quality Care confirming there will be a review of Florida’s long-term-care ombudsman program, “including the circumstances surrounding [the] resignation” of the former head of that program, Brian Lee.   The Administration on Aging will conduct the review into long-term care ombudsman Brian Lee’s dismissal, and will take "all the steps we can to see that the law was followed," said agency spokeswoman Moya Thompson.

In a letter to Charles Corley, the secretary of the state Department of Elder Affairs, the Administration on Aging warned the job must be filled by someone with credibility among advocates for the elderly and disabled and untainted by conflicts of interest.

Governor Scott, who previously ran the Columbia/HCA hospital chain which was found guilty of Medicaid fraud, also founded Solantic, a chain of urgent care centers in Florida.  Scott took money from the nursing home industry in campaign contribution and seems to repaying their generosity now.

See articles from the Miami Herald, the Orlando Sentinel here and here.

The Rock Hill Herald reported the $805,000 verdict in a case involving fraudulent and altered records.  False or inconsistent documentation happens a lot in nursing home cases.  I hope this jury verdict is a warning to those nursing homes who regularly practice fraudulent documentation and cover ups through false charting.  After a weeklong trial in Circuit Court, a York County jury last week awarded $500,000 in punitive damages and $305,000 in actual damages.  Punitive damages, which are usually in excess of provable injuries, are awarded in cases where the defendant’s actions are "egregiously insidious."

A jury ordered the insurance company for a Rock Hill chiropractor to pay more than $800,000 after evidence showed fraudulent records were created to conceal the negligence of the Defendant.  The chart appeared to be changed hours before she was hospitalized.

Plaintiff Cheryl Chandler sought relief for minor back pain from a chiropractor after being referred by her family physician in June 2006.  She went to see Narry Beaver of Beaver Chiropractic and Spinal Rehab in Rock Hill.

Hours after the second treatment, she was admitted to the hospital with "intractable pain," and given morphine. An MRI revealed the need to do surgery to repair the disc in her back.

"It was the most excruciating pain I’ve ever had," Chandler said. "I ended up in the hospital with a ruptured disc. Following surgery, I’ve never been like I was before. I’m always in some measure of back pain."

Chandler sued Narry Beaver and the chiropractic office for negligence in 2008 because Defendants failed to fully evaluate her medical history, perform a proper physical exam, take proper X-rays and were acting outside the scope of chiropractic practice.

"Evidence showed the chiropractor altered his records on his treatment from the day she went to the hospital," attorney Robert Phillips said. "Doctors have to be able to rely on accurate medical records. Altering medical records could put the public’s health at risk."

The Buffalo News reported the lenient sentence for Deborah Groth, one of numerous Williamsville Suburban Nursing Home employees guilty or accused of falsifying records to cover up neglect.    Groth was given a three-year conditional discharge and 50 hours of community service.   Falsification of legal medical documents is a major problem in the nursing home industry according to advocates, academics, and government agencies.

Groth pleaded guilty to felony falsifying business records and had to surrender her state licensed practical nurse’s license for falsely claiming she had properly administered medicine to a diabetic patient.  The plea was the sixth stemming from a hidden-camera investigation of the nursing home, which showed medical records were falsified to cover up the lack of proper care.