WXII reported from the Winston-Salem News in North Carolina on Travis Smith, a custodian for Forsyth Village who was charged with sexual offense.  In November 2011 police were called to Forsyth Hospital on a sexual assault after a woman in her fifties was transported by ambulance from Forsyth Village. The victim said Travis took her into her bathroom and sexually assaulted her. Two months later at the close of the investigation Smith was charged with sex offense institution.

 

 

The New York Times had an interesting article about a serious issue in today’s nursing homes.   What do you do when convicted criminals need skilled nursing care?  If they need skilled care, are they a danger?  How do you keep the other residents safe?

Murderers, drug dealers and burglars, ranging in age from 40s to 70s are supervised by medical staff instead of by prison guards.  Prisoners are being granted medical parole under a 2010 California law "to save the state tens of millions of dollars in medical and guarding costs for permanently, medically incapacitated prisoners. Some of the parolees are bedridden, while others can be moved by wheelchair, and officials said that the parolees posed no threat to others.  There is no requirement that facilities keep their medical parolees in a locked unit, and some do not.  The medical parole program is raising concerns among the state’s long-term care ombudsmen, who investigate complaints from residents of nursing homes."

Facilities that care for medical parolees are not required to inform other patients or their families about the parolees. The ombudsmen receive no formal notification when medical parolees are transferred to facilities in their region.

Is this a ticking timebomb?

Kaiser Health News published an interesting survey that showed doctors are not always honest with patients, especially when it comes to disclosing a medical mistake, or discussing a difficult prognosis.  "Despite wide acceptance of a professional code that endorses openness and honesty with patients, a 2009 survey of 1,891 doctors published in the February edition of Health Affairs found gaps between those standards and how they actually practice."

The vast majority of physicians say they embraced the American Board of Internal Medicine Foundation’s Charter on Medical Professionalism which demands fully informing patients about the risks and benefits of all available interventions.  More than a third said they did not completely agree it was necessary to disclose “all serious medical errors to affected patients.”  "Even more striking, one in five acknowledged they had not fully disclosed an error to a patient in the previous year because they feared a lawsuit."

"More than 55 percent of physicians reported they often or sometimes described a patient’s prognosis in a more positive manner than the facts might support.  Meanwhile, 11 percent of respondents said they had told patients something untrue in the previous year, and 17 percent did not completely agree that physicians should never tell a patient something untrue." 

The authors point out that their estimates may be low because of the tendency to respond to questions in a way others regard favorably.  The survey also found notable variations correlated with race, gender and physician specialty. For instance, women and minorities were significantly more likely to follow standards for honest communication compared to white male doctors, which the authors suggest may be due to greater vigilance about the code on the part of newcomers to the profession.

The Center for Survey Research at the University of Massachusetts, Boston, administered the eight-page survey in May 2009 to 3,500 physicians drawn from seven specialties. Almost two-thirds, or 1,891 completed the survey.

 

Kaiser Health News reported that the American College of Physicians released an updated ethics manual requiring doctors to provide "parsimonious care" – in other words, "to practice effective and efficient health care and to use health care resources responsibly."  Is it ethical to withhold care when the benefits are not cost-effective?

It’s been viewed as a definitive statement of medical ethics directed at the organization’s 132,000 members – physicians who practice internal medicine and its related specialties, among them cardiology and oncology, that often involve expensive procedures. 

Consumer advocates and experts complain that cost consideration ultimately hampers patient care. 

KSTP reported that the staff at Mission Nursing Home had to receive basic training on wound care after a male resident was found to have maggots in open sores on his right foot. "In the facility’s documentation, an aide reported a blister on the resident’s right foot to the nurse at the beginning of September, but the nurse did not follow up with proper treatment. Nearly a week later, another aide discovered two open wounds on the man’s foot and saw maggots in both wounds, as well as in his sock and shoe, said the report. The investigation noted the man did not have feeling in his lower extremities due to diabetic neuropathy."

The resident was hospitalized with cellulitis of the foot and discharged back to the facility after the nearly nine days of treatment. In response to the incident, the facility provided re-education regarding wound and skin care policies and procedures. State health officials say no citations were issued due to the re-training effort.

No citations or fines were given.  That is ridiculous.
 

The Wall Street Journal reported the plight of disgraced Richard Scrushy.  He is getting out of jail earlier than expected following a 2006 bribery conviction, but the founder of HealthSouth Corp. won’t be free of creditors. A $2.88 billion civil judgment in 2009 against Mr. Scrushy for fraud at the rehabilitation chain, where he served as chairman and chief executive, will continue to loom over him for many years after he is released to a Texas halfway house in the coming weeks. Plaintiffs have collected about $25 million from Mr. Scrushy. 

Follow the money…..

The great and informative website ThePopTort published the hypocrisy of Montana lobbyist and lawyer Mark Baker.  Baker talks out of both sides of his mouth on the issue of so called tort reform.

Baker filed a class action lawsuit for Montana wheat farmers, cattle ranchers claiming that “the failed financial firm run by Corzine stole millions from their accounts to pay off its spiraling debts, and that Corzine’s ‘single-minded obsession’ with making MF Global a big player on Wall Street led to the firm’s collapse.”  The farmers had “’hedged’ their crop prices by placing millions in MF Global accounts but MF Global made a series of bad investments — notably in European debt – [and] it began ‘siphoning funds withdrawn from segregated client accounts’ to cover its debts.”

Mark Baker is a lobbyist for the American Tort Reform Association, the DC trade association funded by large corporations that seeks to limit liability for its members.  "Not only that, Mr. Baker specifically lobbied for laws in 2011 written nationally by the corporate-backed American Legislative Exchange Counsel (ALEC), (we’ve covered ALEC quite a bit, like here), which would have placed new burdens on injured Montana victims who bring and win lawsuits, as well as make it more difficult for the state of Montana to hire outside counsel, allowing it to recoup money from corporate wrongdoers for its taxpayers."

"According to lobby report, Mr. Baker supported three bills for ATRA: HB 341, HB 342, HB 585:

HB 341 would limit the interest on judgments for injured victims, but not for corporations. Here’s the ALEC model bill.

HB 342 lowers appeal bond amounts. Here’s the ALEC model bill. This issue has been a huge one for ALEC as far back as we can remember.

HB 585 deals with contracts between state AG’s and outside counsel. It is based on the ALEC model bill. This final bill would interfere with the contractual arrangement between outside counsel and the state Attorney General office, which are generally underfunded and understaffed and can’t hope to take on big industries without outside counsels’ help.

 

The Madison Record reported the lawsuit filed by the daughter of a recently deceased woman against Edwardsville Health Care Center Investors. "Sylvia Mayes claims her mother, Lydia C. Srnek, developed a urinary tract infection while living in defendant Edwardsville Health Care Center Investors’s nursing home. The infection was allowed to linger without treatment and developed into a significant medical problem, according to the complaint filed Dec. 28 in Madison County Circuit Court. Finally, on March 12, 2010, Srnek was taken to Anderson Hospital after she began exhibiting signs of shortness of breath, an altered mental status, severe sepsis, a urinary tract infection, metabolic acidosis, acute kidney failure, significant dehydration and severe malnutrition, the suit states."

Because of the neglect Srnek developed a blood infection, which caused her great pain and suffering until her death on March 21, 2010.  Mayes claims she incurred medical and funeral expenses and lost her mother’s love, companionship, society, affection, guidance and comfort.

Employees at Edwardsville Health Care Center Investors failed to observe that she was suffering from a urinary tract infection, failed to notify Mayes of changes in her mother’s condition and failed to provide her with adequate hydration and nutrition, among other negligent acts.

 

WYFF out of Greenville, South Carolina reported the guilty plea of Michael Dewitt Morgan after pleading guilty to four counts of assault and battery and burglary.  Evidence showed Morgan went into the Magnolia Manor nursing home undetected and unsupervised on Feb. 25 and March 17 and inappropriately touched several residents.  Magnolia Manor is owned and operated by the Fundamental Long Term Care Companies. Morgan was sentenced to 15 years suspended to seven years followed by two years probation.  Morgan will also be placed on the sexual offender registry.

The allegations included Morgan entering a male resident’s room at Magnolia Manor Nursing Facility on Ansel Street, and touched the patient’s genitalia.  Police said that Morgan also went into a female resident’s room and told the woman that he was there to “check her,” and fondled her breasts.  Greenville police said Morgan sexually fondled three women and two men at the Magnolia Manor nursing home.

Sgt. Jason Rampey says Morgan worked for a company that provided services to nursing homes or their residents. That company name has not been released.

 

 The Tampa Bay Times had a great article about the difficulty in holding nursing homes accountable and collecting judgments from oowners and operators especially when no insurance exists.  Complex corporate networks insulate owners from legal claims. Money is shifted around. Private investment firms come and go.

The article reports  "At times, even nursing home regulators cannot tell who is raking in the profits and calling the shots. The estate of Elvira Nunziata is putting that protective shell to the test."

Nunziata and her family was recently awarded $200 million by a jury after she toppled down a stairwell to her tragic death in 2004 while strapped to a wheelchair.  She was unsupervised and passed through an unsecured door without an active alarm.

The company that operated Pinellas Park Care and Rehab Center at the time no longer exists.  Another company had bought the nursing home’s income streams. Another related company inherited its liabilities. The defendant left so few traces that it was left with no lawyer at trial.

The real battle is tracking the money. Motions and countermotions are flying in state and federal courts in Florida, Maryland and Georgia.  How and why did Defendant proceed to trial without an attorney?  In this case, the sole remaining defendant was a shell.

Trans Health Management Inc. had operated 200 homes in 22 states. A Chicago private equity firm and others had created it in 2002 to take over the IHS bankrupt chain. By the time Elvira Nunziata’s estate sued in 2005, "Florida had revoked Trans Health’s corporate status for failure to file annual reports. It was unclear whether the company still ran the Pinellas Park nursing home or if it even existed."

Wilkes & McHugh proceeded with the lawsuit anyway because they hoped to collect from others who bore responsibility. The related companies fought the lawsuit.  By 2009, though, only the defunct Trans Health Management remained as defendant.  However, Wilkes & McHugh had discovered intriguing (and possibly illegal and fraudulent) movements of money.

According to expert forensic accountant Brad Rush, Trans Health’s operations were sold for only $100,000 in 2006 to companies using the same office complex as Trans Health and the same phone number. Fundamental Administrative Services LLC ended up with Trans Health’s management contracts, 35,000 employees and the cash flow, Rush testified.  Fundamental is part of the Fundamental Long Term Care Holdings L.L.C. which is owned by Murray Forman and Leonard Grunstein. Another one of their companies–Fundamental Long Term Care Inc.– inherited the liabilities including potential lawsuit claims — then failed to file corporate reports and disappeared.  

"The only purpose of the Fundamental companies … was to strip assets away,” he said. "No addresses or phone numbers or emails changed. Just the letterhead.”

"Trans Health Management also had a parent company — Trans Healthcare Inc. — that also might be targeted. It still enjoyed income from other subsidiaries, but had entered into receivership in Maryland, a legal status akin to bankruptcy."

"After a Baltimore receivership judge banned further legal action against the parent company, its lawyers stopped defending the Nunziata case. But Wilkes & McHugh saw a possible opening. The receiver had paid GE Capital $55 million to wipe out a loan. Rush testified that loan provisions gave GE tight control over Trans Health’s cash flow. If the receiver had played favorites with GE Capital, maybe Nunziata could tap into that $55 million."

"In 2010, a jury rendered a $114 million verdict against Trans Health companies for a death at an Auburndale nursing home. Same lawyers, same alleged money shuffling, same no-show at trial.  After the verdict, Wilkes & McHugh won court approval to depose executives and examine documents of GE Capital, Fundamental and a private equity fund that created Trans Health."

"Lawyers for Fundamental Administrative Services told the Polk court that the statute of limitations has passed on its acquisition of Trans Health assets."

Nursing home ownership is now split into layers of different companies ultimately owned and operated by the same company or person.  "One might own the building. Another would lease the building, hire staffers and pay the bills. Profits might flow to other corporate parents, holding companies or private equity investors, which have jumped into the field in recent years."

"Charlene Harrington, a professor emerita at the University of California at San Francisco, has studied the nursing home industry for 30 years. Last year, she examined the nation’s 10 largest for-profit chains and found up to five layers of ownership."

"You can’t tell who owns” many nursing homes, Harrington says. "It’s like tracking a problem mortgage when you don’t know who owns the bank.”

"Even the federal government can’t figure it out. Medicare and Medicaid pay most of the nation’s nursing home bills and require homes to disclose their ownership structures. But when the General Accounting Office looked at six big chains in 2010, the information those chains had provided Washington gave no indication of which affiliated companies controlled what."

Lack of transparency can contribute to bad care, said Evin Isaacson, a fellow at the National Senior Citizens Law Center. If regulators can’t decipher who ultimately makes decisions, it’s hard to levy fines and sanctions. And that removes incentive to plow money into care rather than profits.