A New Jersey appeals court ordered a new trial in a medical malpractice case because the award for pain and suffering was too low to adequately compensate the plaintiff for the rest of her life.  The jury awarded $100,000 for pain and suffering.  The Appellate Division ordered a new trial finding the award "grossly insufficient and a miscarriage of justice," but left in place the liability verdict and $800,000 in economic damages.

Maureen Walsh saw a succession of doctors starting in 1995 for circulatory problems in her toes. By the time she met with vascular surgeon George Constantinopoulos in early 1998, she was in severe pain. He recommended an arteriogram, saying it should be done promptly but that another doctor should arrange it because he was not in her health plan.   A subsequent bypass operation showed that amputation might be necessary because painful gangrene had set in. First she lost her foot, then part of her leg and finally, in 1998, most of her leg as the gangrene advanced upward and her leg began to turn colors.

She was 50 at the time, and federal government estimates give a woman of that age a life expectancy of 32.5 years. 


Naples Daily News had an article about Medicare overpaying nursing homes.  Watchdog groups have warned about the overpayment months ago.  The already extremely profitable nursing home industry is getting an extra $1.5 billion from Medicare despite a call from an independent Medicare advisory panel that reimbursement has been inflated for the past three years and needs to be scaled back.

The windfall to skilled nursing facilities comes with no strings attached and there is no reason to believe this windfall will help improve the quality of care or quality of life for nursing home residents,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy Inc., in Washington, D.C.

The overpayment remains even though the Medicare Payment Advisory Commission, an independent advisory group to Congress, recommended in May that the rates be adjusted because nursing homes are being overpaid. The Bush Administration decided this past month to "study" the issue further.

The Center for Medicare has been overpaying nursing homes since January 2006 after expanding the list of categories used in determining patients’ medical status for purposes of reimbursement  .By not addressing the issue now, the nursing home industry will reap an extra $780 million next year, Edelman said.

An Office of Inspector General report in 2006 found that 22 percent of nursing home claims were overcoded for higher reimbursement, he said.

The system used to determine reimbursement to nursing homes is complex. One component alone involves a patient evaluation form with 509 questions, Hamilton said. The forms help determine the nursing home’s reimbursement rates.  This raises questions about how much time staff members have to do the evaluation, how trained they are and whether the patient’s medical record matches the care rendered, Hamilton said.

On a second front, the nursing home industry is receiving a 3.1 percent inflation adjustment that will mean getting an additional $710 million next year from Medicare.  MedPAC had reviewed nursing homes’ operating margins and recommended no cost adjustment to the federal government but the inflation increase is moving forward.


The Urban Institute did a study that showed Americans who go without health insurance.  They will spend $30 billion out of pocket for health care this year alone, and they will get $56 billion worth of free care, according to a report released on Monday.

Government programs pay for about three-quarters, or roughly $43 billion, of the bills for these uninsured people, Jack Hadley of George Mason University in Virginia and a team at the Urban Institute reported.

On average, an uninsured American pays $583 out of pocket toward average annual medical costs of $1,686 per person,  The annual medical costs of Americans with private insurance average far more — $3,915, with $681, or 17 percent, paid out of pocket, the report found.

"The uninsured receive a lot less care than the insured, and they pay a greater percentage of it out of pocket. Contrary to popular myth, they are not all free riders," Hadley said.

Current estimates show that 47 million Americans lack any health insurance, and 28 million have gone without for some part of the year.  

Spartanburg Herald had an article about the emergence of nurses in nursing homes stealing narcotics from residents who need them.  It is shocking that this could happen so often without anyone at the nursing home being aware.  Do they take these drugs while providing care?  That would explain all the neglect and negligence that seems to exist in some of the homes mentioned such as Magnolia Manor and Magnolia Place–both are owned and operated by the national for profit chain of THI and Fundamental Long Term Care Companies which previously ran IHS into bankruptcy.  Maybe the nursing homes should initiate random drug tests of their employees to protect the residents.

More than 650 nurses–one out of every 100 licensed nurses in Spartanburg, Cherokee and Union counties has been disciplined by the state Board of Nursing for a drug-related offense. Half of them stole prescription painkillers from hospitals, doctor’s offices and nursing homes. This doesn’t even count the CNAs who ar enot licensed health care providers.

The nurses have faced disciplinary action for offenses including stealing drugs, forging prescriptions, testing positive on drug screens or coming to work impaired at employers including Spartanburg Regional Medical Center and Mary Black Memorial Hospital. Many returned to work after an evaluation and completing, when deemed necessary, mandatory treatment with the S.C. Recovering Professionals Program, or RPP.  These numbers do not reflect the nurses who did not get caught or the ones where the emnployer looked the other way.

Frank Sheheen, RPP director, said most medical professionals referred to the program didn’t steal medications just once, and many program participants were referred there before disciplinary action was taken. There are "absolutely" more medical professionals in the state "in need of treatment who aren’t getting it," he said. "If they get caught stealing once, how many times have they been stealing?" he asked. "That’s just the one time they got caught."

Drug abuse has increased over the past decade, and the percentage of medical professionals who are addicted to drugs is about 2 percent higher than in the general population, Sheheen said.

Many nurses committed violations that placed proper patient care in jeopardy. In more than one case, nurses came to work impaired from alcohol or medications such as Demerol. One nurse, who was employed as a staff nurse at Magnolia Manor, was suspected of removing Duragesic patches from nursing home patients and reporting to work impaired.

Another nurse admitted to stealing prescription narcotics from Allen Bennett Memorial Hospital in Greer on four occasions. He also admitted that  when he was employed at Magnolia Place nursing home, he stole OxyContin by opening pill packages and replacing the white OxyContin tablets with other white-colored pills, according to board records.

Board records show one nurse admitted to taking multiple drugs from Allen Bennett, including Demerol, Dilaudid and Lortab. The next year, she was fired from Spartanburg Regional Healthcare System, where she had gained employment, for taking a patient’s medication and administering it to herself while on duty. She submitted to a drug screen and tested positive for morphine.

Thom Berry, spokesman for the S.C. Department of Health and Environmental Control, has seen all types of drug cases involving medical professionals across the state. Some cases clearly endanger the patient’s quality of treatment if they’re not receiving the appropriate amount of painkillers, he said.


The purpose of the Long Term Care Ombudsman program in South Carolina is to provide advocates for the elderly and their families.  If you or a loved one is a resident of a nursing home or assisted living facility in South Carolina, the Ombudsman in your region should be able to answer your questions.  Most importantly, if you have a complaint against a facility contact your Ombudsman for help.  Click here for to find out more about the Long Term Care Ombudsman program and to get contact information.  Another resource to try is SCDHEC, or South Carolina Department of Healht and Environmental Control.  This is the agency that licenses and inspects nursing home and assisted living facilites in South Carolina.  Click here for more information.

When making a complaint, whether it is made to the Ombudsman, DHEC, or the facility itself, it is best to do it writing, not verbally, and make sure you keep a copy for your records.


The Toldeo Blade has a sad article about the effects of delays and denials caused by for profit insurance companies making health care decisions for residents instead of health care professionals.  This should be criminal the way the health care industry denied this man’s chances of survival. 

The article discusses various specific cases.   Randy Steele, 64, of Oak Harbor was transferred back and forth between health care facilities as physicians attempted to stay ahead of the hepatitis C virus that was slowly threatening his liver and kidneys.

He was finally referred to specialists at Cleveland Clinic to offer a second opinion on a potentially life-saving kidney-liver transplant. Cleveland Clinic fit Mr. Steele onto its schedule. But instead, his appointment was canceled and he waited weeks to learn if his insurer would pay for this life saving measure.

Mr. Steele, like many patients across the country, was the victim of a complex health-care bureaucracy and an insurance industry that repeatedly denies doctors’ orders — leaving patients bewildered and suffering.

Bill Hodnik, 41, endured the same shortcomings.He suffered months of avoidable pain while his insurer delayed and denied coverage for a necessary surgery ordered by his physician. Mr. Hodnik’s physician told him the optimal solution to his problems would be cutting-edge artificial disc replacement surgery.

The surgery was scheduled, but he never underwent the procedure. After months of repeated delays and denials from his insurer, and with his disability insurance running out, Mr. Hodnik needed to return to work, and so — against doctor’s orders — he settled on fusion surgery.

Doctors nationwide believe there is an emerging crisis in providing health care to their patients because insurers routinely challenge their orders.

Doctors said patients usually receive some of the therapy, testing, medication, or procedures needed and prescribed for them. But too often, physicians said, there’s a lapse in time between the office visit and when the care or test is delivered because of interference by insurers.


Deseret News had an article about the sentencing of a nursing home employee who molested an 85 year old resident where he was employed.  This is a tragic and preventable situation. Why didn’t anyone supervise this CNA?  How could they have hired this guy?  Why did they allow him to plea to a lesser crime? How could they give him such a light sentence?

Jacob Mut Bolith was charged in July 2007 with first-degree felony rape, second-degree felony forcible sex abuse and class A misdemeanor lewdness. However, in a plea agreement, he pleaded guilty to forcible sex abuse, a second-degree felony, and the other two charges were dropped.  He was only sentenced to serve a one-to-15-year sentence and ordered him to pay restitution.

"To do this to my mother … is unconscionable," one daughter said. Her other daughter said a medical exam showed that the defendant did more than "what he admitted."

The article doesn’t mention if the facility knew or should have known about their employee’s tendencies or if they did a background check or if they recieved prior complaints about his behavior or if the State even investigated the nursing home.


The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry.  Will there be a revolution in health care?  Will for profit chains dictate how the old and frail among us will conclude their lives? 

A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility’s staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.

Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if — like Ms. Nguyen and the other Lodi residents — they depend on Medicaid to pay their bills, the officials and advocates say.

Assisted-living facilities have sprung up as alternatives for those who don’t require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks’ notice, with no appeal guaranteed.

In Florida, for example, the state’s 2,400 assisted-living facilities must give residents 45 days’ notice before evicting them, but don’t need to provide a reason or appeal process. 

No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% — nearly twice the growth for complaints overall.  Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.

And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution.  Federal law — enforced by the states — says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days’ notice, explain their appeal rights, and put together a plan to make sure the move doesn’t harm them.

Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.

For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility — for renovations.  All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.

Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital — who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)

In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn’t simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."

The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine’s 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.


On Seattlepi.com there was an article about the tragic death of Lee Ann Steele caused by the understaffing and neglect of a for profit nursing home.

Lee Ann, who had suffered a stroke,  lived at Aldercrest Health & Rehabilitation Center.  She needed a tracheotomy. The Steele family had felt assured by the facility’s promises of skilled, high quality care, but less than 24 hours after their daughter was admitted, her tracheal tube clogged with mucous, causing oxygen loss and brain damage. Lee Ann Steele, once a vibrant church secretary who had volunteered at a food bank, died a few months later, in January 2007. She was 49.

The family wanted answers so they filed a lawsuit against Exyendicare Homes, Inc., the company that owns and manges the facility.   The complaint, filed in King County, accuses Milwaukee-based Extendicare of violating consumer-protection laws by advertising "quality standards above government regulations" and failing to deliver.

The lawsuit highlights problems regarding Extendicare, one of the largest nursing-home chains in America. The company runs 268 facilities for up to 30,000 residents.  In Washington, two of the company’s homes are on a federal list of troubled facilities that require extra inspections by the U.S. Department of Health and Human Services.

Four of its homes, including Aldercrest, have been barred in the past from accepting new residents. Five have been hit with fines totaling thousands of dollars.  Many complaints, including those alleging wrongful deaths, stemmed from neglect and poor treatment for such conditions as pressure sores and diabetes.

She said the company appeared to have a high turnover in management. She also said the homes routinely accepted more residents — and more acutely sick residents — than staff members could handle. 

On Oct. 5, 2006, the day Steele was admitted, her family found her lying on a sheetless rubber mattress and her tracheal-tube equipment on the floor, unhooked, with no one attending to her for several hours.  Steele  suffered respiratory distress and died soon after.