The Fresno Bee had a great article on the problem with nursing homes altering or falsifying records. Falsifying nursing home charts is an epidemic. It is standard practice in the vast majority of nursing homes. Of course, the defense lawyers say everyone makes mistakes but the chart is a legal and medical document where accuracy is key to good care. Medications and treatments are documented as being given when they are not. Inaccurate entries have masked serious conditions in some patients, who ultimately died after not receiving proper care, The article has a few recent examples from California:
A 77-year-old Cameron Park woman, Johnnie Esco, died in 2008 after suffering a fecal impaction so severe her rectum had dilated to 10 centimeters, or about 4 inches. The condition, in which the stool hardens and backs up in the body, is common in elderly or bedridden people and is known to be fatal. The woman’s chart reflected that she had been having bowel movements in the days before her death – an assertion that medical professionals later said would be extremely unlikely, given the severity of her condition.
A supervisor at a nursing home admitted under oath that she was ordered to alter the medical records of a 92-year-old patient, who died after developing massive, rotting bedsores at the facility. In a recorded deposition for the lawsuit, the director of nursing at Rosewood Terrace testified that she had been ordered by the facility’s administrator – along with a corporate representative – to alter the medical records to indicate that Ritter had arrived at the facility with "softened heels.
The corporate representative told the nurse "to falsify the medical records because the current records did not ‘look good’ and he was worried about a lawsuit," according to court papers. Numerous suspicious and "downright fraudulent" chart entries were found involving at least seven different employees.A nursing home was fined only $2,500 by the state for falsifying a resident’s medical chart, which claimed that the patient was given physical therapy five days a week. At least 28 of those sessions were documented by nurse assistants who were not at work on those days.
A woman severely injured at a convalescent home discovered a string of false entries – several written by nonexistent nurses.
A nursing home was fined $800 for making 12 false entries in a patient’s medication record because none of the medications was available in the facility at that time, according to the state-issued citation. The woman missed multiple doses of four drugs used to treat high blood pressure and a psychiatric disorder.
"While regulators have dogged facilities for years over fraudulent Medicare documentation, the issue of bogus records is more than a money matter. In California and elsewhere, nursing homes have been caught altering entries and outright lying on residents’ medical charts – sometimes with disastrous human consequences, according to a Bee investigation."
Some nursing home administrators to re-create medical records to hide neglectful care.
"The idea that they chart things before they happen or make things up way after the fact if something hits the fan – those are things that we’re familiar with," said Mark Zahner, chief of prosecutions for the attorney general’s Bureau of Medi-Cal Fraud and Elder Abuse.
"And we see (this) with regularity." Suspicious or sloppy record-keeping is so common they encounter some aspect of it in virtually every case they investigate. It is part of the culture. It is part of the training.
A Bee review of nearly 150 falsification cases reveals that residents are the victims of records fraud in California nursing homes. The most common patterns include:
• Covering up bad outcomes. A patient dies or is injured, and the nursing home staff or administrators rewrite the records to minimize blame or liability.
• Fill-in-the-blank charting. Overworked or lazy staff members take massive shortcuts, filling out charts en masse, not knowing whether treatments took place or if the information is accurate.
• Missing medicines. Medications are checked off as being given, but investigators later find unopened boxes or discrepancies with pharmacy records.
Less common are accusations that staff falsify consent forms to sedate patients, or backdate forged documents agreeing to settle disputes through arbitration. Attorneys on both sides agree that a medical chart is an integral aspect of patient care – a changing, living record of big events and small. The chart follows a patient, sometimes for decades. Other providers rely on its accuracy to determine care or revise treatment. An accurate chart leads to quality care. An inaccurate one can cause serious harm and cover up the lack of care.
Elder abuse experts agree that fraudulent charting can be traced to understaffing. Public documents reveal tales of chaotic shifts on which certified nurse assistants are scrambling to provide care.
The Bee found several falsification cases in which nursing staff continued filling in the "activities of daily living" on charts of patients who were already dead. Another incident where a nursing supervisor documented that she performed a 35-minute treatment on the elderly man on the day he was hospitalized eight miles away.
Sylvia Saucedo, a retired housekeeper who had been recuperating from pneumonia at Mission Terrace Convalescent Hospital in Santa Barbara. Four days after being admitted in January 2009, she fell, suffering a permanent brain injury. The attorneys said they suspected that the director of nursing had rewritten the assessment to say Saucedo was, in fact, at low or no risk of falling when she checked in. If so, that would potentially diminish the facility’s liability.
Shortly before trial, the attorneys said they suddenly realized that their copy of the director’s assessment did not have enough holes punched in the margin to fit in the original binder.
"It was such an ‘aha’ moment," said Moore. "We thought, ‘These records were never part of her chart.’ "
In 2004, the California attorney general’s office relied on hidden-camera footage in an Escondido nursing home to charge 12 employees with felony elder abuse. Ten of the workers also were accused of the misdemeanor offense of falsifying medical records.
A year later, though, an appeals court found the employees had been improperly charged because the regulations applied to the facility’s owners, not its workers.