March 2012 Archives

March 20, 2012

CMS Announces Campaign to Reduce Unnecessary Use of Antipsychotics in Nursing Homes

I've written here many times as a Pennsylvania nursing home lawyer about the dangers of overusing antipsychotic drugs in nursing homes. Sometimes called "chemical restraints" because the practice effectively prevents patients from being physically or mentally active, antipsychotics were once commonly used off-label in dementia patients. Their use has been curbed somewhat since 2005, when the FDA issued its strongest possible warning that studies have associated atypical antipsychotic use in the elderly with increased risk of death; the agency extended that warning in 2008 to all types of antipsychotics. Nonetheless, a federal report last year found the drugs are still used more widely in nursing homes than they should be, with numerous Medicare recipients getting the drugs for no medically accepted reason or in a way that violates federal standards.

Now, the Centers for Medicare and Medicaid Services has announced a campaign to stop unnecessary use of antipsychotics. According to McKnight's Long-Term Care News, CMS will promote alternatives to medication to control behaviors among dementia patients that are violent or otherwise difficult for caregivers to handle. These can include intervening in patients' behavior, better communication with patients when possible, and treating any problem that might be the real cause of an outburst, such as undiagnosed pain. Nursing home industry observers also called for homes to recheck whether there was ever a valid indication for the medication, and whether it's still valid today. McKnight's reported that this issue has been front and center partly because of interest from Sen. Chuck Grassley, R-IA, who may have driven the CMS initiative. That initiative will kick off March 29 with educational programs as well as increased regulatory oversight.

As a Philadelphia medical malpractice lawyer, I applaud Grassley and the no doubt many others who have been working to keep this issue front and center. Because of their illness, nursing home patients with dementia can rarely speak for themselves, so it's vital that we speak for them. That's particularly true for patients who are receiving antipsychotics unnecessarily, because a side effect of those drugs is sedation. (Indeed, it's possible that sedation is the goal of homes that overuse the drugs.) Like other powerful prescription drugs, however, antipsychotics carry even more serious side effects, including large weight gain, diabetes, sudden cardiac death, stroke and more. That's why knowingly misusing the drugs in elderly people, just to avoid taking the expensive staff time necessary to intervene in their behavior, is a form of Pennsylvania nursing home abuse.

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March 6, 2012

Arkansas Supreme Court Orders New Trial for Family of Nursing Home Negligence Victim - Bedell v. Williams

As a Pennsylvania nursing home lawyer, I was interested to see a nursing home negligence case that was sent back for a new trial that included evidence not previously presented. In Bedell v. Williams, the Arkansas Supreme Court also removed one defendant from the case, finding that the leader of the nursing home's governing body could not be sued in his personal capacity. The victim was Minnie Lee Valentine, who died after two extended stays at Little Rock Healthcare, a nursing home, and trips in and out of other care facilities. Valentine had suffered a severe stroke before entering the home and had a slight pressure sore when she arrived, but that sore worsened as time went on. Before her death, Valentine suffered amputations related to other pressure sores as well.

Valentine suffered a stroke in May of 2004. When she was released from the hospital and into the care of LRHC, she depended on nursing care and had a feeding tube, a pressure sore on her tailbone and a urinary tract infection. She was treated at LRHC, but the pressure sore did not heal and she also began showing signs of malnutrition and dehydration. In June, she was admitted to another hospital for pneumonia, where her pressure sore continued to worsen. After release to LRHC, nurses found signs of infection in the pressure sore, which ultimately led to another hospitalization. After this hospitalization, she was released to a different nursing home, where the pressure sore worsened and new sores developed on her feet and ankles, requiring multiple amputations. She died in February of 2005.

Brenda Williams, the personal representative of Valentine's estate, filed suit against multiple defendants, all of whom were dismissed except LRHC; the president of its corporate owner, Donald Bedell; and Heartland Personnel Leasing, Inc. Those companies were tried on claims of negligence, medical malpractice and violations of the Arkansas Residents' Rights Act, and the jury ultimately awarded $5.1 million to Valentine's estate from LRHC; $350,000 from Heartland; and $5 million from Bedell. All three defendants appealed the outcome, the damages and certain rulings leading up to the outcome.

The Arkansas Supreme Court started by agreeing with Bedell on his claims that he cannot be found negligent because he owed no personal duty to Valentine. The parties agree that Bedell was not personally involved in Valentine's care, the court said, but the trial court nonetheless found a duty stemming from federal law and a parallel internal policy at LRHC. This was incorrect because the federal policy governs Medicare and Medicaid eligibility, the high court said; the LRHC policy was created merely to comply. Thus, Bedell was an inappropriate defendant and the Supreme Court dismissed him. It next turned to arguments that the trial court should have allowed evidence about Valentine's health after her discharge from LRHC. Because the defense argued that Valentine's health was inevitably declining, it should have been permitted to introduce evidence about how she fared after discharge. Failure to include this information was prejudicial, the high court said, and that warrants a new trial altogether. Thus, it dismissed Bedell and remanded for a new trial of LRHC and Heartland. It then addressed other contentions for the purposes of retrial.

As a Philadelphia medical malpractice lawyer, I'm disappointed that this victim's estate and loved ones will have to retry the same case again. This is not just a delay for them, though these delays can be hard on suffering families; it is also an additional expense. Worse, it will not necessarily lead to the same result for them. This case may have been especially vigorously litigated because the verdict was very high, but -- as many nursing home companies know -- verdicts are often very high in cases of Pennsylvania nursing home abuse. Understandably, juries are not impressed by nursing homes that permit, ignore or even encourage abusive conduct and severe neglect of their patients. Patients like Valentine, who was dependent on full-time nursing, are at especially great risk from uncaring or lazy caregivers. As a Philadelphia injury lawyer, I am proud to help families fight this kind of negligence when it happens in the name of profit.

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