I read an article today about the death of a resident caused by the improper transfer by the nursing home staff.  Falls are always so dificult for the elderly to survive.  the injuries cause by falls can lead to immobility, pain, and demntia.  Preventing falls should be a high priority but often isn’t.  Training and staffing are lacking in this area.

A Pennsylvania Coroner concluded a nursing home resident’s death was caused by injuries she suffered after being dropped by staff from a mechanical lift.    Judith Bilger was dropped Aug. 9 and died three days later at the Laurel Crest Rehabilitation & Special Care Center.

Coroner Dennis Kwiatkowski says the 64-year-old woman died from internal injuries caused in the fall.   Among other things, she broke ribs and developed pneumonia from a lung contusion.

Proper staffing and education on proper use of mechanical lifts could have prevented the above incident and prevented this woman’s death.

In the latest issue of the magazine Trial, thereis an interesting article about how medical malpractice settlements are reasonably related to the quality of care provided according to an analysis of 11 different studies on settlements.    The article is in the December 2007 | Volume 43, Issue 12 and the author isValerie Jablow, Associate Editor.

Below is an excerpt of that article:

An analysis of the results of 11 studies of medical malpractice claims and settlements shows that “medical malpractice settlements are neither random nor irrational” and that “quality of care drives settlement outcomes,” with the likelihood of payment and the amount paid “closely related to the merit of the underlying claim of medical negligence.” (Philip G. Peters Jr., What We Know about Malpractice Settlements, 92 Iowa L. Rev. 1783 (2007).)

“People who studied the field have been aware of these findings for some time,” said Philip Peters, a University of Missouri law professor who conducted the analysis. “But the previous descriptions of them have tended to be relatively anecdotal, not attempting to tie them all together in a concrete way to show what the pattern is.”

Tort “reformers” have long alleged that medical malpractice settlements are an “irrational lottery,” where fault and settlement are unrelated, Peters noted in his report. Many critics have relied on a small analysis in the widely cited Harvard Medical Practice Study, which concluded that the merits of 51 malpractice claims examined had no relation to the likelihood of settlement. (Troyen A. Brennan et al., Relation Between Negligent Adverse Events and the Outcomes of Medical Malpractice Litigation, 335 New Eng. J. Med. 1963 (1996).)

Peters looked at that study and 10 others completed between 1988 and 2006 that examined settlements in almost 20,000 medical malpractice cases. He found that the 1996 Harvard study is an “outlier”: Taken together, the data Peters analyzed showed that “weak claims are much less likely to result in a settlement payment than strong claims,” with only 10 percent to 20 percent of weak cases resulting in payment (and then, usually only a “token” amount, such as forgiveness of unpaid medical bills).

Strong cases, Peters found, settle at a higher rate (85 percent to 90 percent) and for much larger average payments. “Borderline” cases fall somewhere in between strong and weak ones.

Peters also found that many cases settle at a “discount,” often for less than their expected value. Such discounts operate in two ways, Peters wrote, “once in the insurer’s decision whether to make any settlement offer at all and again in the size of the offer to make.” He found settlement offers to be significantly less likely in weak cases than in strong ones, and when an offer is made in a weak case, it is significantly smaller.

This “surplus discounting,” Peters noted, reflects the “superior bargaining power of malpractice defendants,” including greater risk tolerance, better access to information and experts, and more experienced lawyers.

The fact that some weak cases settle “does not mean that the process is working unfairly,” Peters wrote. “This conclusion would only be justified if the payments were not being discounted to reflect the weakness of the claims being settled.”

The report also noted that about the same percentage of strong cases—10 percent to 20 percent—get no payment at all.

However, the study also concluded that “to the extent that settlement outcomes depart from the merits, the discrepancies usually favor malpractice defendants. . . . As a result, plaintiffs have more reason to complain about the system’s imperfections than defendants do.”

“Through 11 studies, we have the benefit of people who have accessed the files and found that cases settle much the way ordinary people would handle them if they were lawyers,” he said. “The reassuring finding from these studies is that the civil justice system really is asking the right question: ‘Did the patient get competent care or not?’ The findings show the system works.”

The Wall St. Journal has a great article on the use of medications to sedate residents because of short staffing at many nursing homes.  Below is an excerpt from that article.

Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals — including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer’s disease and other forms of dementia.

Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs.

That is what happened to a woman listed in New York state health department inspection records as Resident #18. The 84-year-old Alzheimer’s patient, who lives at the Orchard Manor nursing home in Medina, N.Y., likes to wander and roll her wheelchair around her unit, according to a report filed earlier this year, and sometimes she nervously taps her foot.

To address her behavior, which was considered disruptive, Resident #18 was given a powerful antipsychotic drug called Seroquel, a drug approved for schizophrenia and bipolar disorder. Resident #18 is not psychotic and Seroquel — like other atypical antipsychotics — carries a "black box" warning that elderly dementia patients using it face a higher risk of death.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York’s nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse. Last month, the Arkansas attorney general filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.

Read More →

Here is a link to an article that discusses a hefty fine for a facility that neglected a resident.

A Riverside County nursing home was fined $100,000 for the death of a 91-year-old woman who was dropped on her head.  Citrus Nursing Center in Fontana was cited last month for failing to provide patient safety, according to the California Department of Health.

The nursing home is owned by Sunmar Healthcare in Brea. A call to owner Frank Johnson on Saturday was not returned.

The elderly patient was injured on Feb. 24 as a nursing assistant improperly tried to transfer her from a wheelchair to a bed without help, according to a health department citation. She died nine days later.

The home also was fined a total of $25,000 last year in connection with the 2004 death of a patient who died from a bacterial infection and for failing to contact a doctor about a diabetic patient whose blood-sugar levels had reached unsafe levels.

Here is an excerpt from a recent article in the Conservative Wall St. Journal.

Last month, health inspectors in New York City shut down Serendipity, an upscale ice cream parlor. Though the closing made headlines, it is a common occurrence for less-famous eateries charged with violations like unclean cutting boards and floors, workers who fail to clean their hands, and improper food handling that could lead to bacterial contamination.

Restaurants in New York are inspected, without prior notice, once a year. In Los Angeles, inspections are done three times a year, and restaurants must display their grade near the front door. After L.A. instituted this inspection system in 1998, the number of people sickened by food-borne illnesses fell 13%, according to the Journal of Environmental Health. Other cities are now following L.A.’s lead.

Why aren’t hospitals {and nursing homes} held to the same rigorous standard? The consequences of inadequate hygiene are far deadlier in hospitals than in restaurants. The Centers for Disease Control and Prevention estimate that 2,500 people die each year after picking up a food-borne illness in a restaurant or prepared food store. Forty times that number — 100,000 people — die each year, according to the CDC, from infections contracted in health-care facilities.

Data recently published by the Journal of the American Medical Association show that infections from just one type of bacteria — methicillin-resistant Staphylococcus aureus (MRSA) — kill about twice as many people in the U.S. as previously thought. The finding is based on lab tests, not on what hospitals report. If the same methodology were used to quantify deaths from all hospital infections, the death toll would likely be much larger than 100,000.

These infections are caused largely by unclean hands, inadequately cleaned equipment and employee’s contaminated clothing that allow bacteria to spread from patient to patient. In a study released in April, Boston University researchers examining 49 operating rooms at four New England hospitals found that more than half the objects that should have been disinfected were overlooked by cleaners.

Testing surfaces is so simple and inexpensive that it’s used routinely in the food industry. Is it more important to test for bacteria in meat processing plants than in operating rooms?

Read More →

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.