A caregiver at Reo Vista Healthcare Center nursing home is accused of raping a disabled patient. Last month, San Diego Police confirmed that detectives referred the case to the District Attorney’s office, which is charging 26-year-old Ariel Chavarin-Camargo with forcible rape and a “lewd act upon a dependent adult by a caretaker”.  According to state documents, it happened last February to a 58-year-old woman who uses a wheelchair and was living in the nursing home after suffering from a stroke.

The documents report that the morning after the alleged assault, she reportedly came “crying” to a nurse, claiming that the night before, when she was returning from the kitchen and on her way back, “one of the CNAs (Certified Nursing Assistants) stated that one of her breasts was exposed.” According to the documents, he “followed her and he exposed his private parts to her”. She reportedly said, “the CNA raped her” for up to three minutes. A forensic exam reportedly found male DNA in her private area.

According to the documents, when he was later questioned, he suggested that she came onto him but admitted “it happened” and “there was penetration”. He reportedly said, “I feel bad. It happened so fast.

In a story that 10News’ Team 10 investigative reporter Jennifer Kastner discovered after a year of being under the radar.  It was a few months ago when 10News was tipped off about Reo Vista Healthcare Center, which touts being named one of Newsweek’s top nursing homes and having a Medicare 5-star rating.

 

Confidentiality and court secrecy kills people.  We all know that.  We have known it for decade since the tragic product liability law suits involving the Corvair and the Pinto.  Reuters reported a recent story about secrecy by government regulators at https://www.reuters.com/investigates/special-report/usa-courts-secrecy-regulators/.   As Reuters has documented in earlier articles in this series, a thick blanket of secrecy covers product-liability litigation in the United States. In just a handful of cases over the past several decades, hundreds of thousands of people were killed or injured by defective products – cars, drugs, guns – while information about the risks was hidden from consumers and regulators, sometimes for years, behind broad protective orders.

The article discusses the Consumer Product Safety Commission (CPSC) and secrecy behind the defective and unsafe design of Yamaha Motor Co off-road vehicle Rhino.  After dozens of incidents, CPSC sent a subpoena to Yamaha, forcing it to hand over a trove of information, much of which had lain hidden under judges’ protective orders in the lawsuits against the company. By then, more than 40 people, including more than a dozen children, had been killed in Rhino crashes.

“CPSC is one of more than a dozen regulatory agencies tasked with protecting Americans from dangerous products. And the Rhino episode reveals a troubling dynamic in the way these watchdogs do their jobs: Sometimes the only way they can learn about and act on a possible threat to consumers is from evidence produced in lawsuits, but that evidence is often hidden behind a wall of secrecy.”

“These orders, though meant to protect specific information such as medical records and trade secrets, often give companies wide latitude to designate as confidential material exchanged between litigants in the pretrial discovery process – internal emails, data, research, meeting minutes, sworn depositions and the like. The secrecy typically persists for the life of the case, and long after, though court documents are, by law, presumed to be public.”

A few years ago, the National Highway Traffic Safety Administration (NHTSA) and CPSC issued pleas for easier access to evidence introduced in court under protective orders. But the Environmental Protection Agency, the Food and Drug Administration (FDA) and 15 other federal departments or agencies surveyed by Reuters did not point to any explicit policy or guidance on gaining access to court evidence potentially relevant to their oversight functions.

Lawyers challenged defendants’ claims of confidentiality for material relating to public health and safety in 26 of the 55 big cases Reuters analyzed, and in most of them, judges refused to unseal the evidence. Some of those cases involved attempts to share information with the FDA.  Judges are human beings who love and care for their fellow citizens.  Lately, they have shown a rare willingness to grant requests from plaintiffs, expert witnesses or news organizations to share information with regulators or the public.

In September, the House Judiciary Committee Chairman Jerrold Nadler planned to reintroduce the Sunshine in Litigation Act to address the problem of court secrecy. The bill would allow parties in litigation to share evidence related to public health and safety with state and federal regulators, regardless of protective orders.

Previous iterations of the bill introduced repeatedly since the early 1990s, despite enjoying bipartisan support, have ultimately failed in the face of sustained opposition from large corporations.  Hopefully, courts will challenge confidential designations that affect the health and safety of people or that cover up fraud.

 

Several Kentucky lawmakers are sponsoring bills to improve conditions in the state’s nursing homes, which have ranked among the nation’s worst. But the powerful nursing home industry will fight any such legislation.  The industry is a big campaign donor with too much political clout.  The nursing home industry is represented in Frankfort by the Kentucky Association of Health Care Facilities, which has given several hundred thousand dollars in political donations in recent years.  Overall, nearly half of Kentucky’s 282 nursing homes are rated as “much below average” or “below average” by the federal government based on poor scores for patient care, staffing and health inspections.

“Inadequate staffing is the basis for so many of problems that we see. Most nursing homes are owned by for-profit companies, and unfortunately, one way that you make a profit is to keep your costs down by not hiring as many people as you should,” said Wanda Delaplane, a nursing home reform advocate in Lexington who has testified to state lawmakers.

Among the proposals is House Bill 215, which would establish minimum safety staffing standards for nursing homes, such as at least one nurse’s aide for every nine residents during day shifts; for every 10 residents during evening shifts; and for every 19 residents during night shifts. The bill also would set rules for how many nurses would have to be on duty at different times to oversee resident care.

Federal law only requires that nursing homes have “sufficient” staff to meet residents’ needs, although states are invited to set their own more rigorous standards. Kentucky has chosen not to, and the state’s nursing homes regularly are cited and sued for neglect as unattended residents fall and get hurt, soil themselves in bed and suffer bedsores from lack of movement.

Two other proposals — House Bill 228 and Senate Bill 36 — would require nursing home staff to be training in properly caring for residents suffering from Alzheimer’s and dementia.

Sen. Reginald Thomas, sponsor of the Senate bill, said he was motivated by his study on a special legislative task force on Alzheimer’s and dementia. Many direct-care workers in nursing homes — who often are low paid and without much training — don’t know how to handle the unpredictable and sometimes aggressive behavior of these special residents, Thomas said.

“In the year 2020, the fact that they get no training in Alzheimer’s or dementia care really does surprise me,” said Thomas, D-Lexington. “This is not a new phenomena. This is a growing trend that we’re been facing with our aging population over the last 20 years.”

Meanwhile, a former executive of Signature HealthCare, Adam Mather, was politically appointed to be the “watchdog” for Kentucky’s troubled nursing home industry. Signature HealthCare is based in Louisville and owns more than two dozen low-rated nursing homes around the state.  Mather will be paid $112,381 a year to oversee a state office that — among other duties — inspects several hundred nursing homes in Kentucky on behalf of the federal government, which pays for the bulk of residents’ care through Medicare and Medicaid.

A Herald-Leader analysis of 42 Signature facilities in Kentucky shows that 25 are rated as “much below average” or “below average” by the U.S. Centers for Medicare and Medicaid Services five-star rating system, which considers quality of patient care, staffing and health inspections.

Signature HealthCare at Jefferson Place in Louisville, for example, was hit with $140,421 in fines in 2018 after inspectors cited repeated cases of resident neglect that led to physical injuries and personal humiliation. It’s rated as one-star, or “much below average.” Signature executives alone have made at least $20,500 in political donations since 2015, according to state campaign-finance data.

“It’s troubling that someone from the industry now gets to oversee the industry,” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy in Washington. Edelman tracks problems with nursing homes nationwide.

“I don’t know him personally, so who knows, maybe he’ll turn into a whistle-blower,” Edelman added. “But generally, I think our regulators should be independent of the industries they regulate and not come from within their ranks. There should not be this revolving door between them, with people moving back and forth. Why not appoint an advocate, someone who cares about the residents and who has a track record of being a little more skeptical of the companies?”

 

Federal watchdogs at the U.S. Attorney’s Office for the Southern District of Florida completed one of the largest Medicare fraud schemes in history with the announcement of prison sentences for modern day Bonnie and Clyde–Rodolfo Pichardo and Marta Pichardo.  The Pichardo are husband and wife each sentenced to several years in prison for their roles building “a vast empire of fraud” from May 2010 through September 2016.  The Pichardos purchased multiple properties, high-end vehicles, expensive jewelry, plane tickets, vacations, cosmetic procedures and more, both for themselves and family members, court documents state. The couple’s empire included at least six fraudulent home health agencies, three fraudulent therapy staffing companies and two fraudulent pharmacies.

Quality Care Home Health Agency, Rapid Home Health Services and Tender Home Health Services were just some of the business names reportedly in the Pichardos’ fraud scheme. Other company names included Alegre’s Home Health Care, B&M Home Health Care, Apple Health Care Services, RP Staffing Inc. and more.

Over the years, the Pichardos and their co-conspirators used their phony network to submit more than $38 million in false and fraudulent claims, according to Department of Justice officials. Medicare ultimately paid out more than $33 million of that.

Rodolfo Pichardo, 71, was sentenced to more than 15 years in prison for health care fraud and wire fraud scheme. Marta Pichardo, 66, was sentenced to eight years in prison for her role in the scheme.

“This case involves the largest fraud scheme in terms of loss amount ever charged in the history of the Medicare fraud strike force,” U.S. attorney Wilfredo A. Ferrer said at a press conference at the time. “The case allegedly involved an elaborate cycle and network of bribery, deceit and kickbacks that compromised Medicare care services for thousands of [Medicare and Medicaid beneficiaries] at south Florida hospitals, skilled nursing and assisted living facilities.”

As part of the Pichardos’ scheme, the couple offered and paid kickbacks to numerous patient recruiters in exchange for referrals to home health agencies that he owned. The conspirators also offered and paid cash kickbacks to owners and operators of multiple Miami-Dade medical clinics in return for acquiring medically unnecessary home health prescriptions for the recruited Medicare beneficiaries.

Prescriptions were then used by the Pichardos’ various home health agencies and pharmacies to bill Medicare for purported services and pharmaceutical drugs that were provided to allegedly qualified Medicare beneficiaries.

During the long-running scheme, the Pichardos took several “calculated steps” to conceal the fraud and avoid detection, according to DOJ officials. That included using nominee owners, changing names and locations of their fraudulent entities, and creating shell companies to hide assets.

 

The Minimum Data Set is the uniform assessment tool for nursing homes to develop a plan of care and reimbursement. Recently, the Trump Administration arbitrarily decided to remove Section G of the MDS.  Section G assesses a resident’s Functional Abilities and Limitations.  Seems kind of important, right?

The decision set for October 1, 2020 is being met with apprehension and confusion in the industry — as it could potentially result in unintended financial and administrative consequences for providers who rely on G to receive proper reimbursements.

  • How will nursing homes be reimbursed for their Medicaid residents without G in the MDS?
  • Will there be more guidance before the October 1 deadline?
  • Will this shift result in decreased Medicaid reimbursements?
  • Will there be additional administrative burdens?

Many states use the old Medicare reimbursement system — the Resource Utilization Group (RUG) model — to determine Medicaid rates, but the RUG system was phased out last October in favor of the new Patient-Driven Payment Model (PDPM). Under PDPM, operators do not assess as often. But the removal of Section G could have nursing homes feeling like they’re taking a step forward and then a step back.

Jodi Eyigor, director of nursing home quality and policy at trade group LeadingAge, confirmed there are still many questions about CMS’s announcement to take out Section G.

“It didn’t seem very clear. When you look at the actual draft, it does seem to indicate that GG will be used for all residents, regardless of payer type and regardless of their stay, but we’ve reached out to CMS to confirm that, and we haven’t received confirmation yet,” Eyigor said.

Some of the same concerns coming out now also arose when PDPM was implemented last year, she added, pointing to the questions about how the states’ reimbursement for Medicaid will be affected.

“So there were questions that came out earlier in the fall that still were not answered,” she added.

 

McKnight’s published an article by industry lobbyists (apologist) American Health Care Association President and CEO Mark Parkinson extolling the alleged virtues of the new Patient Directed Payment Model (PDPM).   It will be interesting to see if data bears this out on a nationwide basis.  Parkinson is happy “because we’ll be saving the system a lot of money, taking care of high-acuity patients in skilled nursing facilities as opposed to the hospital.”

Parkinson, the leader of the largest nursing home association in the country, praised CMS officials for their timely release of software and programs that eased implementation and transition issues. Upcoming quarterly earnings reports from publicly traded companies will reveal just how positive the program is for providers, he explained. Patient outcome data will come much later.

The first two months after the implementation of PDPM saw employment drops, but the trend got worse as the year came to a close — with the losses nearly quadrupling in December.  The national nursing home industry shed 6,700 jobs in December, according to the most recent set of employment data from the federal Bureau of Labor Statistics (BLS), as the overall nursing care facility workforce dipped below 1.6 million. December’s decline marks a sharp increase over the 1,700 positions lost in November and 1,300 shed in October, the first month of the new Patient-Driven Payment Model (PDPM) for Medicare reimbursements.

 

The website Nursing Home Compare, published by the Centers for Medicare & Medicaid Services, is a resource for researching nursing home options for loved ones. The number of falls that lead to injury are a critical category of concern for nursing home residents, however, a University of Chicago researcher has found that the data used by Nursing Home Compare to report patient safety related to falls is highly inaccurate.

“This is a substantial amount of underreporting and is deeply concerning because without good measurement, we cannot identify nursing homes that may be less safe and in need of improvement,” Sanghavi said.

Falls are a leading cause of death among the over-65 population, and they can lead to other serious injuries. Patients become fearful of walking again for fear of reinjury, yet falls are considered widely preventable. They are a discrete event that is easy to identify and record, compared to other clinical conditions on Nursing Home Compare such as pressure ulcers or infections, so there should be a wealth of reliable data.

“That’s why falls are a patient safety measure on Nursing Home Compare,” Sanghavi said. “They reflect how well a nursing home does at preventing these injuries.”

Nursing Home Compare has faced prior scrutiny for using self-reported data. Sanghavi’s own research was sparked by a 2014 New York Times investigation into serious deficiencies found in nursing homes rated five stars by Nursing Home Compare.

“I found it odd that Nursing Home Compare would use self-reported data,” she said. “Having worked with Medicare claims data, I thought I could use it to study MDS reporting. The Medicare claims we used are hospital bills. They want to get paid and should not have an interest in nursing home public reporting. That’s why they are a more objective source than the self-reported data from nursing homes.”

Based on her results, Sanghavi suggests that the Centers for Medicare & Medicaid Services change their evaluation criteria for falls on Nursing Home Compare.

“They should use an objective source, like claims data,” she said. “It should be relatively easy for them to do, since they already have the data. There are other claims-based measures already used on Nursing Home Compare.”

When Krysten Schmidt visited her grandmother at Premier Genesee Center for Nursing and Rehabilitation nursing home, an aide quietly pulled her aside to share there were maggots on her grandmother’s foot.  Schmidt said that if it hadn’t been for the aide, she might never have known that maggots – fly larva that look like small worms – were infesting her grandmother’s leg wounds at Premier Genesee not only that day but also four days earlier.

Two nurses who responded to Schmidt’s demands for an explanation downplayed the maggots, the granddaughter said.

“My mother had just arrived for the visit and took off the shoe and sock and three or four maggots fell to the floor,” Schmidt said. “They proceeded to tell me the maggots were in her shoe and not her sock. I mean, does it really matter? Are maggots supposed to be anywhere? They were trying to downplay it.”

Later that same day, Schmidt said, she filed a complaint with the state Health Department, which initiated an investigation in early October.  Staff at Premier described the Sept. 25 incident to a state Health Department investigator in graphic terms. On Mary Ellen Sharp’s left foot, there was “something wiggling between her toes,” a nurse’s aide told investigators.  In the state investigation report, the director of nursing told an investigator that the licensed practical nurse who initially discovered the maggots has been banned from working at the facility “for lack of nursing supervision notification.” The licensed practical nurse, however, told the investigator she not only recorded the incident in Sharp’s file, but also informed a registered nurse and tried “many times” to alert the nursing supervisor by phone, pages and texts, but could not reach her. The state cited Premier Genesee for violations but incredibly did not fine the nursing home.

An inadequate pest control program to prevent flies from entering and spreading maggots at the 160-bed nursing home was cited by the Health Department as the culprit.  A maggot infestation on a nursing home resident’s body is a very disturbing violation of minimum care standards.  An adequate pest control program includes making sure screens remain properly fitted in windows and eliminating gaps in doors to block flies from entering, making sure bug light traps are plugged in and that monthly recommendations for repairs from a pest control company are promptly addressed.  The best intervention would be to care for and treat the resident’s wounds every shift.

The state cited other problems:

• An unsanitary situation occurred when a wound doctor, after treating one of Sharp’s wounds, failed to place a dressing on it. For hours, the wound was openly exposed, making it a target for flies.

• Officials at the nursing home failed to comply with a federal regulation requiring they immediately notify a physician and relatives when there has been a change in a resident’s condition.

• Breakdowns in communication among employees, ranging from the nursing staff to maintenance workers.

“What happened is inexcusable and horrifying,” said Lindsay Heckler, supervising attorney at the Center for Elder Law and Justice in Buffalo. “Had staff followed basic standards of care and timely notified the physician, maggots would not have infested the resident’s leg for additional multiple days. Maggots should not have infested her leg on Sept. 21, and the resident should not have been left to suffer from further infestation.”

“You don’t really think it could be true or it could ever happen,” Schmidt said of the maggots. “How would anyone feel having that happen to a loved one?”

 

 

As we all know, abuse and neglect are rampant in the industry.  Skilled nursing facilities are also required to notify federal and state agencies of potential abuse and neglect. Allowing facilities to self-report and then refusing to punish them when they cover up incidents increases the likelihood that abuse and neglect will continue.  Reports of nursing home staff slapping patients, calling them names, and leaving them in their own filth all day are made to law enforcement but are not reported to state and federal agencies obligated to investigate.

NBC26 I-TEAM compared police reports at PruittHealth nursing home with federal reports over the same 12-month period. What they uncovered is reports going to law enforcement are often for “information only” whatever that means. For example, one resident called the police after laying in his own waste and filth for over 9 hours but the report is listed as “info only” and the officer immediately closed the case. It was never investigated as neglect. There was no investigation.

The news is shocking because neglect is a punishable offense like abuse. Staff is required to report those allegations to law enforcement. In fact, a staff member called police after Glenn made a similar complaint about lying in his own waste for too long the previous year. Staff member stated she “wanted the incident documented.” But like the other one, this was listed as information only — not neglect.

We looked 12 months of police reports. In one report, a nurse allegedly hit and slapped a patient with pressure sores. It’s listed as a medical complaint. In another, an employee allegedly berated a patient, calling her “ugly ugly” while taking picture to show her just how ugly she is. It’s information only, too.

More than half of these 28 reports are information only.

Federal complaint investigations were compared with local police reports. None matched each other. This isn’t just a local problem. Last year, the inspector general determined nursing homes across the country aren’t reporting potential neglect and abuse. Nursing homes are graded partially based on these investigations.  Every agency is looking at the other agency to investigate.

Crimes Against the Vulnerable and Elderly (CAVE) made its first nursing home arrest last year. CAVE operates on the Georgia side. South Carolina has no such task force.

 A convicted serial killer who spent nearly 30 years behind bars walked out of a federal prison and will live in Fort Mill, S.C.  Catherine Wood worked as a nurse’s aide at the Old Alpine Manor nursing home in Michigan when she and Gwendolyn Graham, murdered five women ages 60 to 98.  It was reported that the serial killer duo even chose their victims by their last names, wanting to spell out the word murder with their initials.  All of the victims suffered from dementia or Alzheimer’s disease.

The case in 1987 made national headlines, and her victims’ families said her future neighbors in York County should be very worried. They did not mince words, saying they believe Wood may kill again.

“I feel sorry for the people who have to live around her, quite frankly,” said John Engman. His mother-in-law, Mae Mason, was one of those murdered. “I think she is a danger to society. I would certainly think they (authorities) are going to keep an eye on her — at least for two years. But after that, she can go wherever she wants.”

Wood testified that Graham suffocated the victims with washcloths and she acted as a lookout. But investigators believed Wood was more involved, and there could have been as many as a dozen victims.

Graham was serving a life sentence without the possibility of parole, but Wood walked out of a federal prison in Tallahassee, released over the objections of families of the women she helped kill, fearing she’ll kill again. She served nearly 30 years for her second-degree murder conviction.

The parole board had denied Wood’s release eight times before, finding she was a potential danger and wasn’t remorseful.

Retired Walker, Michigan Police Sgt. Roger Kaliniak, who helped investigate the murders at Alpine Manor Nursing Home in 1987, fears the 57-year-old Wood will kill again.

“She’s a serial killer and she could do it again, and most of them do,” he said. “I believe that Cathy Wood was the mastermind, she was the one that was pulling strings on Gwendolyn Graham. Gwendolyn Graham handled the dirty work and Cathy Wood was the brains behind it. ”

The South Carolina parole board said the terms of Wood’s parole will keep her away from the elderly, children and vulnerable adults. But her parole ends in June 2021.

“My fear is that she will find some old person, old people, incorporate herself into their family, take their property, take their lives and move on and do it again,” Engman said.

Graham and Wood, dubbed “The Lethal Lovers,” worked together to smother the five patients as part of a lover’s pact, according to the New York Times. It’s those salacious details that led to the case being featured on Oxygen’s “Killer Couples” in 2014. The channel provided an episode description saying, “A pair of female serial killers turn a nursing home into a hotbed of sex, scandal, and murder.”

Two years later, Graham and Woods were the inspiration behind a 2016 episode of “American Horror Story,” where two fictional nurses named Miranda and Bridget decide to kill their patients.

The case was also the basis of the 1992 true crime novel, “Forever and Five Days: The Chilling True Story of Love, Betrayal and Serial Murder in Grand Rapids Michigan” by Lowell Cauffiel.

An overview of the book reads in part, “Wood and her lover, Gwen Graham, make a pact to kill those whom they were hired to care for. No one notices when an elderly person dies a quiet death, but as these two slip deeper into their plan, the terrible secret becomes unbearable.”