A Florida nursing home, Casa Mora Rehabilitation and Extended Care, will pay an $18,500 fine after neglecting a dying resident, and mishandling the resident’s death.  A nurse failed to administer life-saving attempts to a 58 year old woman who was unresponsive. The nurse thought the resident had requested not to be resuscitated, even though the woman wasn’t wearing a bracelet that identified DNR.

The resident’s daughter claimed that the facility hadn’t followed the necessary procedures to keep her mother alive.  The Florida Agency for Health Care Administration investigated her claim and agreed that the facility was negligent.  In addition to the fine, the facility will implement new procedures which will hopefully prevent incidents like these in the future.

See article at MySunCoast.

The Arkansas Times reported a jury in Arkansas returned a unanimous verdict finding that the Greenbrier Nursing and Rehabilitation Center had been negligent in the care and treatment of Martha Bull.  Bull was admitted March 28, 2008 for 30 days of short term rehabilitation. During the night of April 6, 2008 she was in severe pain, sweating and unable to have a bowel movement. Nothing was done. The next shift, she continued to complain. A physician was finally called at 2:20 p.m. April 7. He ordered her transferred immediately to an emergency room. The director of nursing received the fax at 3:34 p.m., but was leaving for the day.  The nursing director failed to properly communicate the order.  No one saw the fax or was aware of it til after she was found dead.  Bull wasn’t sent to the emergency room. She screamed throughout the afternoon, so loudly that residents on other halls complained. She was found dead at 10:20 p.m. April 7. The faxed physician’s order was found the next day.

The jury found the nursing home guilty of negligence, medical malpractice and violation of resident’s rights.  The poorly trained and overworked nursing staff failed to follow doctor’s orders for emergency services and treatment of severe abdominal pain.  The jury awarded damages for pain, suffering and mental anguish at $5.2 million.

Even a frivolous and unsuccessful defense appeal will only be the beginning of a long road toward collection, if any.  Defense counsel spent all the liability insurance coverage for legal costs and fees — $100,000 in this case.   Defendants hired six different defense lawyers.  The nursing home is controlled by Central Arkansas Nursing Centers, a private company headed by Michael Morton of Fort Smith.  The individual nursing homes were organized as “freestanding limited liability corporations”, with licenses separate from physical property and small liability insurance policies through a self-insurance-style program based in Bermuda.

The nursing home fought the case for four years but as a trial strategy admitted in the early stage of the trial “that a mistake was made.”  The admission of a mistake came only after the trial began. If sincere, it should have done so long ago, expressed regret and demonstrated sincerity by trying to make things right.

The price tag of American medical services has been increasing for years, but this new study finds that the price for an average ER trip has become more than what some people spend on rent.  A new NIH study found that the average cost of an Emergency Room visit was over $2000, 40% more than most people spend on their rent each month. ER trips can have a large price tag, but because of the range in pricing, most Americans have no idea what the final cost will be. This study finds that when the IQR, interquartile range, is factored in, Americans pay more or less than the average prices of these services. The study looks at the most common reasons for visiting the ER and doesn’t factor in how much of the cost will be paid by insurance.

The IQR represents the difference between the 25th and 75th percentile of charges, meaning that it shows the variation between charges. The study looks at the top 10 most common reasons for visiting the ER: sprains and strains, other injury, open wounds, normal pregnancy/delivery, headache, back problems, upper respiratory infection, kidney stone, urinary tract infection, and intestinal infection. The average charge and the IQR are compared. This study shows that what people should be charged, the IQR cost, is rarely what they’re charged. In almost all instances, the average charge is higher than what it should be.

If the median IQR is what most people should pay, why are some people paying more and some people paying less? The healthcare system needs more transparency in its pricing and cost evaluations. Because when people do the math, it just doesn’t add up.
See article at ThinkProgress.


The NY Times had an article on a special emergency room designed specifically for the elderly.  Hospitals have strong financial incentives to focus on the elderly. People over 65 account for 15 percent to 20 percent of emergency room visits, hospital officials say, and that number is expected to grow as the population ages.   Under the Affordable Care Act, the health insurance overhaul passed by Congress in 2010, hospitals’ Medicare payments will be tied to scores on patient satisfaction surveys and how frequently patients have to be readmitted to the hospital. 

Arrivals go through triage in the regular emergency department and are sent to the geriatric department if they are over 65, know their name, were able to walk before the day of the hospital visit and are ranked 3, 4 or 5 on a standard emergency severity index of 1 to 5, with 1 being the sickest.  The geriatric E.R.include nonskid floors, rails along the walls, reclining chairs for patients and thicker mattresses to reduce bedsores. To keep the noise down, the curtain rings and rods around the beds are made of plastic instead of metal.

Then there is the geriPad, an iPad that lets patients have a two-way video conversation with a nurse, or touch the screen to ask for lunch, pain medication or music.   Still, the move toward specialized emergency rooms for the elderly has skeptics, who see them as little more than marketing gimmicks.



79.7% of uninsured patients seeking emergency care in four San Diego hospital ERs could have had some form of government insurance, but did not, according to research cited at health policy journal Health Affairs by the Foundation for Health Coverage Education (FHCE) (www.CoverageForAll.org).  The analysis shows that a significant issue facing the uninsured is not the availability of free and low-cost programs, but the poor communication and faulty application processes that need to be streamlined.  The American Hospital Association estimated hospitals lost $36.5 billion in uncompensated care due to underpayments for service by Medicaid in 2009.



The data was uncovered through an analysis of the FHCE’s Eligibility Survey results, which also found that 61.7% of national online respondents seeking to obtain coverage were likewise unaware that they were eligible for government coverage. .




Key findings:

 · 79.7% of patients were eligible for state and federal health coverage programs,

· 16.9 % were eligible for private coverage – this includes group coverage of 2 or more employees, individual coverage with medical underwriting, COBRA and Cal-COBRA,

· 3.3 % were eligible for high risk pool coverage – this includes California’s state-run high risk pool, Major Risk Medical Insurance Program, and the newly implemented Pre-Existing Condition Insurance Plan (PCIP).



Key findings of the Online Survey, which was given to web visitors from all 50 states and Washington D.C., include:

· 61.7 % of respondents were eligible for state or federal health coverage programs, most of which require individuals to have income of $44,700 or below for a family of 4 to qualify,

· 21.1 % were eligible for private coverage – this includes individual, group, or COBRA and MiniCOBRA,

· 15.4 % were eligible for high risk pool coverage – this includes state-run high risk pools, as well as the newly implemented Pre-Existing Condition Insurance Plan (PCIP).


The blog posting was written by four health care leaders, Leonard D. Schaeffer, Alain Enthoven, Ph.D., David S. Helwig, and Phil Lebherz, executive director of FHCE.


Based on the Eligibility Survey findings and analysis of the current application system, the authors suggest the best strategy for solving the dilemma is to use point-of-service enrollment. When a person without insurance seeks treatment, a trained staff member in any qualified health care setting could simply go to an online address, input basic patient data, check for available options, and promptly enroll the person in the relevant government health coverage program. Point-of-service enrollment would have automated check-points for eligibility and implement a transparent system with fraud controls. Through point-of-service enrollment, the government could significantly reduce a costly administrative system that drains resources.



The Foundation for Health Coverage Education is a non-profit organization with a mission to help simplify public and private health insurance eligibility information in order to help more people access coverage. The CoverageForAll.org website and U.S. Uninsured Help Line (800-234-1317) receive over 100,000 visitors or callers each month. For more information, visit www.CoverageForAll.org , friend us on Facebook or follow us on Twitter (@CoverageForAll).



 The Syracuse Post Standard had an article recently discussing the (small) fine that a nursing home received for neglecting a resident who died as a result of choking.  How could they levy such a small fine for a preventable death? 

The government fined a Minoa nursing home $13,300 for failing to provide prompt emergency care to a choking resident who died.  The Centers for Medicare & Medicaid Services said The Crossings put residents in immediate jeopardy and provided substandard quality of care, the most serious deficiencies.

The Crossings was one of four nursing homes in the region fined for poor care between June 1 and Sept. 19, according to the Long Term Care Community Coalition.   The fine against The Crossings stems from an Oct. 15, 2007, incident involving a resident:  The report said:

The woman was served a dinner of blueberry pancakes and sausage that a nurse aide cut into bite-sized pieces. A short time later, the aide noticed the women’s mouth was open, she was not breathing and her lips were blue.  The aide failed to call a "code blue," an announcement that alerts all staff to an emergency situation and summons them to provide assistance. It also activates the 911 system. The aide also failed to start the Heimlich maneuver.  A licensed practical nurse who came to help did not take these steps, either.  The registered nurse supervisor who arrived on the scene did not immediately call a "code blue" or 911.

I wonder what "a short time later" means?  I am surprised the nursing home did not claim that the resident had a DNR so they did not need to intervene!!

Alabama NewsChannell 19 had a horrendous story of neglect on their website.  NewsChannel 19’s Carson Clark reported that a Marshall County Nursing Home is in trouble with state and federal officials after a patient died there. A doctor says the Golden Living Center in Boaz allowed a young woman to scream for help for more than six hours, before finding her dead.

The patient, 20-year-old Felicia Ann Engle of Boaz, suffered from kidney disease. She had to be placed in Golden Living because her father was no longer capable of taking care of her needs.

According to state records obtained by NewsChannel 19, Engle began to yell for help around 3:00 p.m. on April 3, 2008. The records quote nurses at the facility, with one saying Felicia was, "…begging us to call her doctor that something was really wrong this time. She was hurting so bad it was unbearable."

The nurse tells investigators she went to another nurse to tell her of Engle’s request. The nurse reportedly replied, "Yes, we know, we’ve heard all about it four times at least."

NewsChannel 19 contacted Dr. Tom Geary with the Alabama Department of Public Health in Montgomery. He says the way in which Engle was treated violates the law.

"If the patient requests to go to the hospital, [if] they say something is wrong, I need to go to the emergency room, they are supposed to take them to the emergency room. They are not supposed to make a judgment that the person is just trying to disrupt the normal services in the facility, close the door and leave them alone," he says.

The director of Golden Living, Kevin Cogan, refused an on-camera interview and asked NewsChannel 19 to leave the property when they visited.

Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident’s life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman’s doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident’s distress. The facility’s director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman’s documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home’s assessment and care planning process. Federal regulations also reaffirm residents’ rights to informed consent and to refuse treatment.

Regardless of a resident’s mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident’s right to refuse treatment. Without a court order, the provision of any treatment over a resident’s express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident’s best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents’ critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.