The News & Observer had an article about the civil lawsuits that have been filed against Britthaven after a Britthaven nurse heads to court on murder charges in the morphine-related death of a patient, and serious injuries to two other patients.  Registered nurse Angela Almore ihas been charged with second-degree murder and patient-abuse charges related to the death of 84-year-old Rachel Holliday and morphine-induced injuries to six other patients.   A medical examiner reported that Holliday died of pneumonia and that the levels of morphine in her system likely contributed to her death. None of the patients had been prescribed morphine.

The case of Jadwiga Orlowski v. Britthaven Inc. is one of the cases pending.  The suit accuses Britthaven of negligence, including failure to monitor Orlowski, who suffered from dementia according to the complaint, and not providing a bed with side rails.

Her husband, Marian Orlowski, died of pneumonia on July 16 at age 86.  Orlowski was a former distinguished professor in pharmacology at The Mount Sinai School of Medicine in New York, was nominated for a Nobel prize in 2004 for his pioneering drug treatment for blood-plasma cancer.

"Later on that same day, Dr. Marian Orlowski was found on the floor of his room," states a legal complaint filed by the Orlowskis’ attorney, Carmaletta Henson. "He had fallen and sustained serious personal injuries, including a fracture to his left hip."

Britthaven of Chapel Hill is one of four "special focus facilities" in the state. This designation by the federal Centers for Medicare and Medicaid Services notes a pattern of substandard care. Chapel Hill Health and Rehabilitation, along with the Brian Centers in Goldsboro and Gastonia (owned by SavaSeniorCare), are also on the list.

Last year, CMS ordered Britthaven of Chapel Hill to pay $216,400 in fines because it was out of compliance with Medicare requirements. Those penalties stem from the case of Mary Lou Barthazon, a 95-year-old woman who likely broke both thigh bones near her knees on Sept. 30, 2007, when a nursing assistant dropped her while trying to lift her from a chair to her bed, according to a federal judge.  The nursing assistant ignored Barthazon’s care plan, which required a mechanical lift.  Her fractures went untreated for two weeks because the nursing assistant did not report the incident. Barthazon’s daughter, Anne Blanchard, insisted Barthazon go to the emergency room on Oct. 14. She died four days later.

Blanchard has sued Britthaven, alleging negligence and wrongful death. In her motion to dismiss the lawsuit, Britthaven lawyer Pamela Robertson denies "that defendants had a duty to supervise or control the clinical care, treatment or judgment of any healthcare provider."

Robertson’s motion also denies "that either state or federal nursing home standards, policies, regulations, rules or standards of participation establish the standards of health care applicable to Britthaven of Chapel Hill."

Britthaven tried to avoid a trial by forcing the case to arbitration. Superior Court Judge Abraham Penn Jones concluded that the contract was signed under duress as both she and her mother were suffering serious health problems and her 23-year-old daughter had only months earlier suffered partial paralysis in a rollerblading accident. Wrote Jones, "The contract is … procedurally and substantively unconscionable."


The Chicago Tribune had an article about new details in the OmniCare kickback scheme that included many of the country’s for profit nursing home chains.  Omnicare — which supplies medicine to roughly 1.4 million nursing home residents in facilities across the U.S. and enjoys an 85 percent share of this market.  Court documents add new details to a whistle-blower lawsuit alleging that the giant pharmaceutical firm Omnicare Inc. paid kickbacks to Illinois’ most prominent nursing home families.

The new filing, which contains 164 pages of internal company records and other documents, is intended to bolster pending civil allegations that Omnicare significantly inflated the purchase price it paid in 2004 for a pharmacy company purportedly controlled by Chicago nursing home operators Philip Esformes and his father, Morris Esformes.

Omnicare’s $32 million purchase of that company, Total Pharmacy, included roughly $16 million that was a kickback to secure long-term pharmacy contracts with nearly three dozen nursing homes the Esformeses operated or controlled

The new documents include copies of handwritten notes from a March 2004 meeting at Morris Esformes’ Lincolnwood headquarters between Omnicare CEO Joel Gemunder and Morris Esformes to discuss the sale of Total Pharmacy to Omnicare.   Gemunder offered to pay $15 million for Total Pharmacy if three-year contracts were in place with Esformes-controlled homes, $20 million if there were five-year contracts and $25 million if there were 10-year contracts. In the final sale, Omnicare paid the $25 million and let Total Pharmacy keep $7 million worth of accounts receivable, making the sale worth $32 million.

The new court filing also includes other handwritten notes taken two days after the meeting that allegedly show Morris Esformes agreed to backdate nursing home pharmacy contracts "in order to avoid the appearance of impropriety," according to the lawsuit.

Philip and Morris Esformes, who are listed as part-owners of 28 nursing homes in Illinois and Florida, and had ties to others in Missouri, have not been charged with any crime in the sale of Total Pharmacy.

The whitsle blowers include two industry insiders: pharmacy executive Maureen Nehls, who served as vice president of pharmacy operations for Total Pharmacy, and former health care dealmaker Adam Resnick, a consultant to Total Pharmacy at the time of the sale.

The Tribune in April reported that the Esformeses were embroiled in what prosecutors called a "horrific" patient-brokering scheme in which unsuspecting nursing home residents were shuttled to and from a local psychiatric hospital for unnecessary treatments. 

Government authorities in Boston have won settlements in federal court based on Resnick’s information about other deals involving Omnicare and separate East Coast nursing home chains including Mariner and SavaSeniorCare owned and operated ath time by Murray Forman and Leonard Grunstein.

The False Claims Act allows private citizens to file lawsuits against companies and individuals defrauding the government and recover funds on the government’s behalf.


WLKY out of Kentucky reported the indictment for neglect by nurse Elizabeth Toyse who was employed at Golden Livings Nursing Home.  Based on the records, Golden Living and Elizabeth Royse knew the resident was at risk of dehydration, but neglected to execute her duties which include monitoring the patients fluid intake and inadequately supervising the nursing assistants.

The neglect led the resident to become hospitalized.  The Cabinet of Health and Family Services conducted a survey in 2007 of the facility, where Golden Livings received a regulatory Type A citation.


McKnight’s Long Term Care News had an article reporting a study on how well nursing homes follow Do Not Resuscitate (DNR) orders. Nursing home residents who fill out forms through a certain end-of-life care documentation program are more likely to receive the care they request than those with only a Do Not Resuscitate (DNR) order, according to a new study.   The study, which looked at the medical records of 1,711 nursing home residents in three states, found that patients who requested pain management care were 59% less likely to receive unwanted treatments than patients with simple DNR forms.
Originally developed in Oregon in 1990, the Physician Orders for Life-Sustaining Treatment (POLST) program is now in nursing home and long-term care facilities in roughly 32 states. Both physicians and patients sign a medical order form detailing the patient’s end-of-life treatment preferences, including CPR, hospitalization, feeding tubes and other interventions.PLOST patients requesting fewer interventions also received identical treatments for pain and other symptoms compared with other patients.

The main point of PLOST is to increase communication between physicians, patients and providers about end-of-life care wishes, according to the Coalition for Compassionate Care of California. The study also found that 98% of PLOST patients had specific end-of-life directions, compared with 16% of DNR patients. The report appears in the July edition of the Journal of the American Geriatrics Association

Chicago Breaking News Center and Chicago Sun-Times had articles on the tragic case of Jean Engstrom who drowned in a bathtub while unsupervised at Warren Park Nursing Pavilion.  Chicago police are conducting a death investigation into the drowning. 

An autopsy conducted determined that Jean Engstrom, 51, drowned according to the Cook County medical examiner’s office. But officials could not indicate from the autopsy whether the woman’s death was a homicide or an accident.   The woman was mentally ill and lived at the Warren Park Nursing Pavilion.  Police were called to the nursing home after staff members found the woman in a bathtub with the water running. They tried to revive her and called paramedics to the home who then took her to the hospital where she died.

Since the woman was mentally ill, she most likely needed supervision.  I wonder if a staff member started the bath (that is why the water was still running) and walked away.  I hope it was an accident.

Congratulations to Jay Reinan who recieved a verdict and an Order allowing for punitive damages against SavaSeniorCare et al.  The case is Reigel v. SavaSeniorCare L.L.C and related companies.

On the claim of wrongful death, the jury awarded Plaintiff $75,000.00 in compensatory losses and $150,000.00 in punitive damages, for a total wrongful death verdict of $225,000.00. After reducing the punitive damages to the amount of the compensatory damages pursuant to the Court’s Order of June 16, 2010, the total wrongful death award is $150,000.00.  Total interest on the wrongful death claim is $51,151.71. The total judgment on the wrongful death claim is $201,151.71.

As to the extreme and outrageous conduct claim, the jury awarded $125,000.00 in compensatory damages and $100,000.00 in punitive damages.  Three years, four months and 24 days of pre-judgment interest on $225,000.00 at 9.0% per annum, compounded annually equals $76,727.56. The total judgment on the extreme and outrageous conduct claim is $301,727.56.

Total judgment in favor of the Plaintiff and against all Defendants shall enter in the amount of $502,879.26.

The Times-Standard had an article about the decision by Plainitff’s attorneys in their successful class action case against understaffing in California nursing homes to participate in mediation to resolve the dispute despite the recent verdict in their favor.

The Humboldt County District Attorney’s Office and lawyers for both sides signed a stipulation and order — essentially an agreement to begin mediation — with the purpose of reaching a settlement.  The agreement was reached the day before the trial was set to continue before the jury with the punitive damages phase.

The stipulation and order mandates that a stay be enacted in the case, which postpones any further court action. The trial is currently scheduled to resume on Aug. 9, at which time any remaining issues will be tried in a court trial with a judge rather than a jury.

In the meantime, the plaintiffs have agreed not to seek any relief of the previously announced jury verdict (some $677 million in statutory damages and restitution). The defendants, in turn, agreed to not file for bankruptcy or seek any relief from a court under Chapter 11 of the United States Bankruptcy Code, which would allow for a reorganization of assets.

The mediation negotiations are slated to begin July 25. The stock market responded immediately to the agreement, with shares spiking at $3.21 Thursday morning after Skilled Healthcare released a statement acknowledging the stipulation before closing at $2.78, well above the Wednesday closing value of $2.25.




Dennis B. Roddy reported in the Pittsburgh Post-Gazette a case where the PA Appeals Court  declared that a local nursing home and its owner may be held liable in a patient neglect death.  The court’s ruling means that nursing home owners can be sued for neglect in any of their homes. Corporate negligence liability includes not only hospitals and health maintenance organizations but also nursing homes.  The judges concluded that Grane, the parent firm, played a substantial role in managing the Highland facility, including establishing quality assurance.

"We conclude that plaintiff’s evidence established that both Highland and Grane acted with reckless disregard to the rights of others and created an unreasonable risk of physical harm to the residents of the nursing home," the court declared in its ruling. "The record was replete with evidence that the facility was chronically understaffed and complaints from staff continually went unheeded."

Peter Giglione represented Richard Scampone in his suit on behalf of the estate of his mother, Madeline Scampone. She died from neglect Feb. 9, 2004, at Highland Park Care Center. Mrs. Scampone died of dehydration caused by understaffing.  Medical records were falsified and water was not provided to residents because the employees were overworked.

The Scampone estate won a judgment of $193,000 but sought and won a new trial after arguing that Judge Robert J. Colville erred in allowing the home’s owner, Grane Healthcare, to be excluded from the suit.

The court also declared that employees of the company "not only were aware of the understaffing that was leading to improper patient care, they deliberately altered records to hide that substandard care by altering [Activities of Daily Living records] that actually established certain care was not rendered."



Juanita Jackson became a resident of IHS of Florida, Auburndale, in March 2003 for short term rehabilitation. Her family planned for her to regain her strength so her children could resume caring for her at home.  Trans Healthcare Inc. and Trans Healthcare Management operated the nursing home at that time.  These companies are part of the corporate maze of sham LLCs that were created by Murray Forman and Leonard Grunstein and others to shield them from accountability.  The company is now known as Auburndale Oaks Healthcare Center.

Ms. Jackson was at risk for falls, but the facility did not take proper preventative measures to ensure she would be safe from falls. Within two weeks of her admission, she fell. She suffered a closed head trauma and fractured her upper arm, which she never fully recovered from. Due to short staffing Ms. Jackson didn’t get turned enough and developed numerous pressure ulcers. They didn’t give her enough to eat and drink, causing her to become malnourished and dehydrated. She was also overmedicated during her stay. Ms. Jackson was left to lie in bed so long that she developed contractures, where the muscles shrivel up, making movement even more difficult. Ms Jackson’s family removed her from the nursing home in May 2003, but she died several weeks later.

Suit was filed July 2004. In May 2009, Plaintiff’s Motion to Amend to Add Claim for Punitive Damages was granted. After years of delay and obstruction from the corporate defense lawyers causing unnecessary litigation costs, and days before a Pre-Trial Conference, defense counsel moved to withdraw from the case. In June the Court allowed defense counsel to withdraw.  Defendants chose not to hire counsel for trial.  The insurance money probably ran out–why else would they abandon the case after defending it for years? 

Later, Defendants declined to defend themselves, and accepted default as to liability.  The only issue at trial was the amount to compensate the family and punish the corporate owners who mismanaged the facility.  The owners have probably bled all the assets out of the companies–where did all the money go?

Lance Reins and Blair Mendes of Wilkes & McHugh tried the matter for two days before a Polk County, Florida jury and presented live testimony from three former employees, the family and a physician expert. The jury entered a $114 million verdict with Trans Health Management, Inc. and Trans Healthcare, Inc. each bearing 50% liability. The Plaintiffs elected damages in accordance with Florida law which reduced the award to $110 million.

The verdict is believed to be the largest awarded by a Polk County jury and followed allegations that Jackson’s treatment at the facility was the cause of her death and that she was injured after falling and then received other injuries from “pressure sores, overmedication, malnourishment, and dehydration,” said The Ledger.



The Milwaukee-Wisconsin Journal Online had an article about seven lawsuits filed against Mount Carmel Health and Rehabilitation Center, which has been cited for 35 care violations this year alone.  Wisconsin’s largest nursing home is fighting evidence of substandard care in seven lawsuits, including six filed in the past six months.

In one case, staff repeatedly reported seeing a resident for more than 10 hours, even though he had fled the facility and was arrested for prowling.  The seven pending lawsuits allege that Mount Carmel chronically is understaffed and that residents in the 473-bed home are not getting adequate care.

Kindred Healthcare, the Louisville, Ky., company that owns Mount Carmel, simply is trying to maximize profits, said Jeff Pitman, a Milwaukee lawyer whose firm is handling four of the seven lawsuits.

Among the allegations in the lawsuits:

• Lack of care led Vicenta Hernandez, 94, to suffer a fall and broken hip, which resulted in her death in November 2007.

• Mary Eva Richey, a one-month resident, developed multiple pressure sores that led to her death in January 2009.

• Edmond Strehlow, who lived at Mount Carmel for 3  1/2 months until April 2007, suffered multiple pressure sores that led to his death.

Richard Abel of Muskego said he visited his late wife, LaVerne, five days per week at Mount Carmel and that staff often ignored her pleas for help in getting to the bathroom and failed to keep a brace on her knee. Abel said he complained to staff and their supervisors on the floor, and then to administrators.

In January 2009, Kindred Healthcare, a successor of Vencor, resumed operation of Mount Carmel. After operating with a probationary license for one year, Kindred was given a full license in January of this year.

The citations issued this year include allegations that Mount Carmel:

• Failed to provide appropriate supervision and assistive devices to five out of 10 residents identified by the nursing home as being at risk for falls.

• Failed to assess and treat pain, depression and other problems experienced by a 51-year-old woman who speaks Spanish and who had part of her right leg amputated last December.

• Did not treat 16 of 32 residents reviewed "in a manner that maintained their dignity."