The Kansas City Star reported the $1.5 million verdict against the Jefferson Health Care home for the wrongful death of Ova Dycus.  She died as a result of a preventable fall.  Dycus was a vulnerable adult who had a high risk of falling. All interventions needed to be implemented to protect her but they were not.

She fell after a staff aide left her standing in her room after a shower the night of Sept. 22, 2007.
The aide did not report the fall to the home’s nursing staff and Dycus’ broken right hip went undiagnosed and untreated for at least 19 hours.

She died 6 days later.

New Public Citizen Report finds Medical Malpractice Payments hit record low.  Analysis discredits claim that Medical Malpractice litigation is to blame for health care costs. Medical malpractice payments in 2011 were at their lowest level on record by almost any measure, discrediting the claim that these payments are to blame for the skyrocketing cost of health care.

Public Citizen analyzed data from the federal government’s National Practitioner Data Bank (NPDB), which tracks malpractice payments on behalf of doctors. The report found that the number of medical payments and the inflation-adjusted value of such payments were at their lowest levels since 1991, the earliest full year for which such data is available.

The report found that in 2011:

The number of malpractice payments on behalf of doctors (9,758 payments) was the lowest on record, having fallen for the eighth consecutive year;

The inflation-adjusted value of payments made on behalf of doctors ($3.2 billion) was the lowest on record. In actual dollars, payments have fallen for eight straight years and are at their lowest level since 1998;

The average size of medical malpractice payments (about $327,000) declined from previous years;

Four-fifths of medical malpractice awards compensated for death, catastrophic harm or serious permanent injuries – disproving the claim that medical malpractice litigation is “frivolous”;

Medical malpractice payments’ share of the nation’s health care cost was the lowest on record (just 0.12 percent of all national health care costs); and

Health care costs rose again amid the decline in medical malpractice litigation – debunking the claim that the litigation is tied to rising health care costs or that patients should expect dividends from reduced litigation;

The total costs for medical malpractice litigation for doctors and hospitals (as measured by liability insurance premiums paid) have fallen to their lowest level in two decades. They amounted to 0.36 percent of national health care expenditures in 2010, the most recent year for which such data is available.

There is no evidence that the decline in medical malpractice payments is due to safer medical care, the report said. Studies routinely conclude that there is a high prevalence of medical errors; for instance, the U.S. Department of Health and Human Services found that more than 700,000 Medicare patients suffer serious injuries from avoidable errors every year, with fatal outcomes for 80,000 of these people.

In contrast to the hundreds of thousands of injuries (and tens or hundreds of thousands of deaths) that major studies attribute annually to medical mistakes, fewer than 10,000 medical malpractice payments were made on behalf of doctors in 2011, demonstrating that the vast majority of patients injured by medical malpractice are not being compensated, the report found.

The only sensible response is for policymakers and physicians to dedicate themselves to pursuing patient safety to prevent these injuries and deaths with the same vigor with which they have previously sought to restrict patients’ legal rights.”

 

WHBF had an article on the quality of CNA staffing at nursing homes.  "Many home aides who care for the elderly in the United States have no training and don’t undergo stringent background checks or drug tests, a new study finds. In some cases, the caregivers get no supervision from the agencies that hire and place them."

Dr. Lee Lindquist, an associate professor at Northwestern University’s Feinberg School of Medicine was the lead author of the study. Her study looked at the qualifications of caregivers who visit the homes of the elderly to assist with daily activities such as dressing and meal preparation. They are expected to help with nutrition assistance, housekeeping, and scheduling medical appointments.  CNAs perform 90-95% of the direct care to residents of nursing homes.

Without adequate quality control measures, the frail elderly may be vulnerable to abuse, fraud or neglect according to the study published in the July 13 issue of the Journal of American Geriatrics Society.  According to background information in the study, the typical aide is a recent female immigrant, earning $7.25 an hour on average or, for live-in help, $5.44 an hour.

 

Kaiser Health News had an article on ObamaCare.  They list 10 things that most people do not know about the health care law.

1.  Postpartum Depression (Sec. 2952)
Urges the National Institute of Mental Health to conduct a multi-year study into the causes and effects of postpartum depression. It authorized $3 million in 2010 and such sums as necessary in 2011 and 2012 to provide services to women at risk of postpartum depression.
 

2.  Abstinence Education (Sec. 2954)
Reauthorizes funding through 2014 for states to provide abstinence-only sex education programs that teach students abstinence is "the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems." Federal funding for these programs expired in 2003.

3.  Power-Driven Wheelchairs (Sec. 3136)
Revises Medicare payment levels for power-driven wheelchairs and makes it so that only "complex" and "rehabilitative" wheelchairs can be purchased; all others must be rented.

4.  Oral Health Care (Sec. 4102)
Instructs the Centers for Disease Control and Prevention to embark on a five-year national public education campaign to promote oral health care measures such as "community water fluoridation and dental sealants."

5.  Privacy Breaks for Nursing Mothers (Sec. 4207)
Requires employers with 50 or more employees to provide a private location at their worksites where nursing mothers "can express breast milk." Employers must also provide employees with "a reasonable break time" to do this, though employers are not required to pay their employees during these nursing breaks.

6.  Transparency on Drug Samples (Sec. 6004)
Requires pharmaceutical manufacturers that provide doctors or hospitals with samples of their drugs to submit to the Department of Health and Human Services the names and addresses of the providers that requested the samples, as well as the amount of drugs they received.

7.  Face-to-Face Encounters (Sec. 6407)
Changes eligibility for home health services and durable medical equipment, requiring Medicare beneficiaries to have a "face-to-face" encounter with their physician or a similarly qualified individual within six months of when the health professional writes the order for such services or equipment.

8.  Diabetes & Death Certificates (Sec. 10407)
Directs the CDC and the HHS Secretary to encourage states to adopt new standards for issuing death certificates that include information about whether the deceased had diabetes.

9.  Breast Cancer Awareness (Sec. 10413)
Instructs the CDC to conduct an education campaign to raise young women’s awareness regarding "the occurrence of breast cancer and the general and specific risk factors in women who may be at high risk for breast cancer based on familial, racial, ethnic, and cultural backgrounds such as Ashkenazi Jewish populations."

10.  Assisted Suicide (Sec. 1553)
Forbids the federal government or anyone receiving federal health funds from discriminating against any health care entity that won’t provide an "item or service furnished for the purpose of causing … the death of any individual, such as by assisted suicide, euthanasia, or mercy killing."
 

The Blotter on Statesman.com reported on the arrest of Katrina Calvert-Hervey for taking prescription medicine from nursing home patients at New Hope Manor and giving it to her boyfriend to sell, according to the arrest warrant.  She had access and opportunity.  She worked as a state-certified medication aide at New Hope Manor nursing home.  She was charged with diversion of controlled substance by registrants, dispensers and other certain persons.

 Police searched the house of Calvert-Hervey and her husband on April 23 and found 219 dosage units of controlled substances including alprazolam, lorazepam, methadone, morphine, methylphenidate and hydromorphone. Calvert-Hervey admitted that while working she stole controlled substances and non-controlled prescription medications from patients by documenting that the patients had received their medicine and then taking the medications home with her.

 

 

Canton Rep reported on Ohio’s attempt to reduce the theft of prescription drugs in nursing homes and assisted living facilities. The attempt is one of several state initiatives aimed at reducing the abuse of prescription painkillers, which has led to record numbers of accidental overdose deaths in Ohio.  Another proposal targets emergency room doctors and their role in the large numbers of prescription painkillers disbursed in the state.

 

Newsday reported the below Opinion of Karen Angel about the misuse and overuse of anti-psychotics in nurisng homes.

A nurse from my mother’s nursing home calls to ask if it’s OK to put her on a new drug. Just a low dose to calm her, the nurse assures me.

I agree, thinking the nurse is an expert and probably knows best. And I’ve seen my mother’s mood change dramatically for the worse as the day wanes, a phenomenon in dementia patients called "sundowning."

The drug the nurse administers is the antipsychotic Risperdal. I later find out that the FDA has issued its strongest safety caution — known as a "black box warning" — against using this drug and similar antipsychotics in elderly dementia patients because they pose an increased risk of death, stroke, seizures and diabetes.

"They’re not supposed to be used to control dementia-related so-called bad behavior," Richard Mollot, executive director of the Manhattan-based Long Term Care Community Coalition, told me. "A lot of family members are being told ‘we need to calm down your loved one’ when in fact this is not appropriate care for people with dementia."

A report this month by the inspector general of the Department of Health and Human Services found that 99 percent of nursing home records show a failure to follow federal safety and quality guidelines for the use of antipsychotics, suggesting drug misuse is widespread and enforcement lax.  But along with heightened scrutiny by HHS, a recent government crackdown against drug companies for illegally marketing antipsychotics is providing a ray of hope that this could change.

Introduced in the 1990s, these "second-generation" antipsychotics have largely replaced drugs created in the 1950s to treat schizophrenia, in part because the newer medicines have been considered safer, with fewer troubling side effects. Almost 40 percent of nursing-home residents with dementia received the drugs in 2010, according to the Center for Medicare and Medicaid Services. Partly as a result, antipsychotics are now the top-selling class of pharmaceuticals, with yearly revenue of about $14.6 billion — despite their approval for only about 1 percent of the population.

The federal Nursing Home Reform Act of 1987 established "the right to be free of unnecessary and inappropriate physical and chemical restraints" — but the government has failed to enforce this. In fact, as a campaign against physical restraints has all but eradicated them over the past two decades, chemical restraints have become more entrenched — even as the issue has been hotly debated in Congress.

"The way antipsychotic drugs are used in nursing homes is a form of elder abuse," Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, told the Senate Special Committee on Aging in 2010. "Instead of providing individualized care, many homes indiscriminately use these drugs to sedate and subdue residents."

 

The largest study of the use of such antipsychotics, conducted by Harvard Medical School and published earlier this year, found that elderly dementia patients using them are almost twice as likely to die as those on a placebo. David Graham, associate director of the Food and Drug Administration’s Office of Drug Safety, has estimated that 15,000 elderly people die in nursing homes every year as a result of the off-label prescription of these antipsychotics.

Last year, a report by the inspector general found that 88 percent of successful Medicare payment claims for antipsychotics were for nursing-home residents with dementia, despite the documented risk of death, and 22 percent of patients were on the drugs for too long or at too high a dose, violating federal rules on unnecessary drug use. The report condemned nursing homes’ failure "to comply with federal regulations designed to prevent overmedication."

Fifty-one percent of the claims in the study didn’t meet the government’s Medicare reimbursement rules — but were paid anyway. This means the Medicare system is shelling out hundreds of millions a year to pay for these drugs, with taxpayers footing the bill. If nothing changes, costs will explode over the next two decades as 10,000 baby boomers a day become eligible for Medicare.

No enforcement action was taken as a result of the report, the inspector general’s office said, because the data were drawn from a random nationwide sample and weren’t sufficient to establish patterns at particular nursing homes.

Beyond their physical risks, antipsychotics are problematic because they not only suppress dementia patients’ agitation, they wipe out pleasurable emotions, too. "They turn people into zombies," Mollot says.

Patients on these drugs sleep a lot. Now it’s clear to me why my mother would be in bed by 6 p.m. at the nursing home, while since moving back home and stopping the drug, she often stays up watching classic movies past 9.

 

Though the government hasn’t gone after nursing homes, it has recently won four big settlements against drug giants for illegally marketing antipsychotics. Last year, Eli Lilly and Pfizer paid the largest criminal fines in U.S. history — $515 million and $1.3 billion, respectively — for deceptive promotion. In a case in Arkansas last April, Johnson & Johnson was fined $1.1 billion for misleading doctors about Risperdal’s risks.

Meanwhile, a federal case is pending against Johnson & Johnson for allegedly paying millions in kickbacks to Omnicare, the nation’s largest long-term-care pharmacy, to recommend Risperdal for nursing-home patients.

In another promising reform initiative, the Center for Medicare and Medicaid Services has launched a campaign against antipsychotic use in nursing homes, with the goal of reducing it by 15 percent by 2013 through alternatives such as increased staffing and better pain management.

Yet, though commendable, these efforts have done little so far to change practices on the ground level for a population that has no time to spare.

I recently asked my mother if she still gets pleasure out of life, even though in the past year, she has gone from being independent to relying on a full-time caretaker for all her basic needs. She replied, "Absolutely!"

All elderly deserve that chance. But until nursing homes face greater scrutiny and sanctions, our elderly will continue to languish in chemical restraints.

 

The Silver Haired Legislature (SHL) is made up of one-hundred-and five seniors through-out Alabama.  SHL is an organization that advocates for laws to protect vulnerable elderly residents.  One of their founders, Hazel Kine, recently addressed to Alabama legislature on the epidemic of sexual abuse in nursing homes.

They are asking the Alabama legislature to pass a bill that guarantees that residents of nursing homes and other care facilities receive notification when anyone with a sexual abuse history is admitted.  The group is also asking the state to require more staff between the hours of 10PM and 6AM to protect the residents and prevent neglect and abuse.

Carol Oden, Silver Haired member says, "It’s frightening, it’s frightening, I would hate to know that I was next door, and not know that that person can come in and do things to me and me unable to get help."

 

The Des Moines Register reported that 2 nursing homes and their corporate masters were fined a combined total of $875,000.

One of the violators was HCM Management Inc., which runs 11 Iowa nursing homes, and it has agreed to pay $200,812 for allegedly employing workers who had been barred from working in federally funded health care facilities.

Separately, the inspector general’s office entered into a settlement agreement with Bethany Lutheran Home, a 121-bed Council Bluffs nursing home that apparently overbilled the government for Medicaid and Medicare therapy claims.  The settlement that they pay $675,000 to the federal government and enter into a so-called “corporate integrity agreement” that requires the home to provide additional staff training in determining what services can legally be billed by nursing homes to Medicaid and Medicare. It also creates additional layers of oversight that apply to Bethany Home’s billing practices and quality of care.