Pennsylvania Nursing Home Abuse Attorney Blog

As a Pennsylvania nursing home lawyer, I was interested to see a trial court decision in Kentucky that could be bad news for nursing home residents in that state. In Abell v. Bardstown Medical Investors, Inc., Christine Abell sued a nursing home where she had been a resident, Life Care Center of Bardstown, for gross negligence, intentional and wanton conduct and disregard for her safety, stemming from alleged denial of care and mistreatment. The home moved to dismiss the case because Abell had signed an arbitration agreement on admission. Abell opposed that motion, saying the contract was not enforceable because she had been mentally incapacitated when signing it. She also argued that the contract was unconscionable and therefore unenforceable.

After a bad fall, Abell, 74, went to the hospital with a vertebral fracture. At that time, she lived in an "independent living facility." After three weeks in the hospital, she was discharged to the nursing home. When she was admitted, a nursing home employee noted that Abell suffered from a major mental disorder and requested a mental health screening. There was no indication that Abell was generally of below-average intelligence or impaired in another way. The screening found that Abell had not previously been treated for a mental health problem and suggested that any problem she displayed could be related to an infection. Directly after the screening, she was given a total of 37 intake papers to sign, including the arbitration agreement.

Abell argued that the arbitration contract should not be enforced because she was physically and mentally compromised when she arrived at the home; and because it was just one of many contracts in a large stack of paperwork. The court rejected this idea. The arbitration contract was not procedurally unconscionable, it said, because it was not intentionally unclear about its meaning and consequences. The court also dismissed Abell's argument that she didn't have the mental capacity to sign contracts when she was admitted. Under Kentucky law, sickness and distress are not adequate to create mental incapacity; Abell had to show that she did not and could not understand what she was signing. The record doesn't show any diagnosis of mental illness or impairment, the court wrote. Furthermore, there was no such diagnosis after she was admitted, and the screening said she did not have a serious problem. Thus, the court dismissed the case and granted the motion to compel arbitration.

As a Philadelphia injury lawyer, I would be interested to know what Abell's major mental disorder was, if it was not any kind of impairment. Arbitration agreements are an ongoing issue in nursing homes, in part for reasons similar to the ones raised in this case. Older people who are candidates for nursing homes are often sick or suffering from mental problems, which makes large stacks of paperwork like the one presented to Abell legally troublesome. Furthermore, an arbitration agreement makes it more expensive and difficult to hold homes responsible for Pennsylvania nursing home abuse, and less likely that the case will get media attention and warn others away from bad homes. As a Philadelphia medical malpractice lawyer, I urge clients to carefully consider everything they sign before entering a home and ask as many questions as they like -- because the patient is, after all, the client.

Continue reading "Court Finds Mental Incapacity Not a Bar to Enforcing Arbitration Agreement- Abell v. Bardstown Medical Investors" »

As a Philadelphia medical malpractice lawyer, I wrote disapprovingly last month about the push among nursing home companies for an exemption from the Affordable Care Act. The Act is the official name of the health care reform law that has become the focus of several political fights, and one of its many provisions requires companies with 50 employees or more to provide health care to their employees. Companies that failed to do this would be fined. At least one industry group has told the media that the homes cannot afford to provide it because they have only a limited ability to raise their prices. Now, according to a June 20 article from Healthcare Finance News, nursing home patient advocates are actively opposing this with a letter of protest to the federal Department of Health and Human Services.

The group of 24 patient advocacy organizations was headed by Families for Better Care, a Florida-based group run by a former Florida nursing home ombudsman, Brian Lee. The letter called the industry's request an "outrage" that could have "disastrous consequences for residents." By exempting health care workers from the requirement to provide health insurance, the letter argued, the government would allow nursing home employees to continue coming to work sick, exposing their vulnerable patients to illnesses their compromised immune systems find hard to fight off. The letter also pointed out the very high rate of workplace injuries suffered by direct-care workers and the low wages that make it difficult for them to take time off or buy insurance in the open market. In an accompanying press release, Lee pointed out that nursing homes are largely government-funded and profitable. A McKnight's Long-Term Care News article suggested that the industry may be moderating its request.

I hope so. As a Pennsylvania nursing home lawyer, I do not believe it is in the best interests of anybody but nursing home owners to give them an exemption. People in the lowest-paid jobs frequently work when they're sick because they can't afford a doctor or a day off. Giving these workers access to basic health care would allow them to call in sick less often and get better faster. Not only would this limit residents' exposure to illness -- a goal in any facility where contagion is likely -- but it ensures that care is not interrupted by frequent turnover or substitutes. And that, as research has repeatedly demonstrated, reduces the chance of Pennsylvania nursing home abuse, neglect and other negative outcomes for patients. When the federal government considers this requests, as a Philadelphia injury lawyer, I hope it does so with patients' best interests in mind.

Continue reading "Patient Advocates Ask HHS Not to Exempt Nursing Homes From Health Care Reform" »

As a Pennsylvania nursing home lawyer, I was interested to read about a bill that could change the way nursing homes handle allegations of abuse, neglect and other regulatory violations. According to a June 12 article from the Standard-Speaker of Hazelton, a committee of the state Senate passed a bill last week that would give nursing homes the opportunity to hire an independent third party to investigate allegations against them by the state. The bill, if passed, would give homes the option to choose conventional investigation by the state Health Department or a third party investigator, which they would pay for themselves. It is backed by the Pennsylvania Health Care Association, a business group that represents nursing homes, and is being reviewed by the SEIU.

The bill by Joseph Scarnati, a Republican from Jefferson County, is intended to address complaints by the nursing home industry that the Health Department cannot be objective. Because Health Department workers often find the violations in the first place, or investigate complaints from taxpayers, the homes believe the Health Department has an incentive to validate those workers' findings. Under the bill, findings by independent companies would be implemented only with approval from the Health Department. If the department disagrees, it would be able to make a written recommendation. The companies would come from a list maintained by the department, and nursing homes would pay for their own inspections. Scarnati said that means it wouldn't cost the state any extra, and a spokesperson for the PHCA said the obligation to pay would make homes carefully consider what they dispute.

This bill is not law; it still has to pass both houses of the state legislature. As a Philadelphia injury lawyer, I hope that before legislators vote, they carefully consider what else the nursing home companies might be buying when they pay for their own inspections. Independent companies that depend on nursing homes for their business might find they have a financial incentive to come up with the results their customers want -- no health violations. If the Health Department doesn't have the time or resources to dispute this, it could allow hundreds of health code violations to go unaddressed. And while inspections would cost the homes money, that cost would likely be dwarfed by the cost of a single nursing home abuse lawsuit from a family using the state inspection results to prove there were problems at the home. As a Philadelphia medical malpractice lawyer, I also think it's appropriate in some ways for the Health Department to have a "bias." It should be biased in favor of whatever is safest for elderly and disabled Pennsylvanians, because accountability is an important tool for fighting Pennsylvania nursing home abuse.

Continue reading "Pennsylvania Nursing Home Bill Would Give Homes More Tools for Abuse Allegations" »

I've written here several times as a Philadelphia medical malpractice lawyer about the use of antipsychotics in nursing home patients with dementia. The FDA has not approved antipsychotics for use controlling outbursts from patients with dementia, but a May study from the federal Department of Health and Human Services found that 88 percent of antipsychotic prescriptions filled by Medicare were for patients with dementia. Critics say this exposes the elderly patients to unnecessary health risks, while advocates say they're the best option available and the risks are overstated. On June 1, CNN.com ran op-ed articles on both sides of the debate, authored by HHS inspector general Daniel Levinson and psychiatrist Daniel Carlat.

Levinson said his office began investigating the use of atypical antipsychotics, a newer and more expensive generation of drugs, after a member of Congress asked about their use. Of the nursing home patients taking atypical antipsychotics under Medicare, he wrote, one-fifth were taking them in a way that violated Medicare standards. About half of the claims shouldn't have been covered at all, he said. This was especially concerning, Levinson wrote, in the wake of multiple settlements by drug companies for illegally marketing atypical antipsychotics and in one case, paying kickbacks.

In his piece, Carlat acknowledged that illegal advertising happens. Nonetheless, he defended atypical antipsychotics as less dangerous than studies have suggested. Many of the causes of death named in the studies, he said, are the most common causes of death for dementia patients overall. And despite being prescribed off-label, the drugs are effective at calming dementia patients who get confused and agitated as their memories and abilities fade. Geriatric psychiatrists try non-drug interventions, he said, but they do not always work.

As a Pennsylvania nursing home lawyer, I wonder how much of Carlat's article applies to a typical nursing home patient. The trouble with antipsychotics in dementia patients is frequently that their doctors are prescribing automatically, without a real examination. The doctors in question may not be psychiatrists or geriatric specialists, and nursing homes know that Medicare-funded drugs are quicker and less expensive than behavioral interventions. For this reason, I hesitate to believe that atypical antipsychotics are not misused. As a Philadelphia injury lawyer, I also wonder whether Carlat glossed over the risks of atypical antipsychotics. The drugs' increased risk of cardiovascular and metabolic complications has led to the FDA ordering a black box warning for the labels, the strongest available. And using antipsychotics as off-label sedatives may cut down on yelling and physical attacks, but keeping patients too drugged to experience life is a form of Pennsylvania nursing home abuse.

Continue reading "Psychiatrist and Federal Inspector General Debate Use of Drugs in Nursing Homes" »

As a Pennsylvania nursing home lawyer, I have used this blog to follow the story of the Delaware County nursing home where three ex-employees are accused of abuse. That home, the Quadrangle Sunrise Senior Living Center in Haverford, had its license pulled by the state in late April after a resident's family caught abuse on videotape. Now, as NBC Philadelphia reported May 27, the Quadrangle has received a new provisional license, covering only six months. The provisional license requires Sunrise Senior Living, the parent company, to meet multiple extra requirements to stay open, including implementing new hiring and training requirements; using independent oversight; and hiring an overnight manager for the dementia unit. Sunrise has a month to meet most of the requirements and 90 days to hire a full-time administrator with human services experience.

The Quadrangle hit the news after the family of Lois McCallister caught McCallister's abuse on a "nanny camera" disguised as a clock. Three employees -- Samirah Traynham, Tyrina Griffin and Ayesha Muhammed -- were taped making fun of McCallister and refusing to let her get dressed or leave the room. They have been fired and face elder abuse charges, with an arraignment scheduled for June 16. The state also pulled the Quadrangle's license to operate, saying its management failed to report abuse allegations, failed to investigate employee backgrounds quickly enough and made mistakes with medications and residents' belongings. Sunrise appealed that decision, and it's unclear whether the provisional license will end that appeal. The Philadelphia Inquirer noted that a provisional license can be pulled at any time.

As a Philadelphia medical malpractice lawyer, I am cautiously optimistic about this deal. The deal between Sunrise and the state DPW requires Sunrise to make major changes in the way it runs the Quadrangle, including new staff, more training for existing staff and independent oversight. If they work the way they're intended, these measures could prevent more Pennsylvania nursing home abuse -- which is what everyone wants. Closing this home might be appropriate if it's unable to clean up its act, but if it's not necessary, it's best for patients not to move. The state may revoke this temporary license if it does not feel that Sunrise is living up to expectations. And of course, this move doesn't take away the right of McCallister's family to pursue its nursing home lawsuit, so they can collect damages for the injuries to her dignity as well as the very real financial strain of finding other elder care. As a Philadelphia injury lawyer, I wish them good luck and hope Sunrise can make the needed changes at the Quadrangle.

Continue reading "Haverford Home Implicated in Nursing Home Abuse Case Gets Provisional License" »

As a Pennsylvania nursing home lawyer, I was interested to see a recent piece on how health care reform affects nursing homes -- as employers rather than care providers. As the New York Times reported May 15, many nursing homes are lobbying Congress for an exception to the employer mandate part of the Affordable Care Act because they're concerned about the cost of insuring their employees. The Act will require all employers with 50 employees or more to offer health insurance starting in 2014, with a financial penalty for failing to do so. The homes say they need an exemption because they depend heavily on Medicare and Medicaid, whose reimbursement rates are going down rather than up. As a result, they say, they can't simply raise the price of the service they provide.

According to the Times, one in four nursing home employees does not have health insurance. The president of a nursing home industry group told the newspaper that employees who do have insurance typically don't have very good benefits, which means they may also not meet the Act's standards. Employees also dropped coverage when they couldn't afford it. The nursing home industry is exploring several ways around the Act, including laws that would allow homes to deduct the cost of penalties for non-coverage from their taxes; a waiver or reduced fee for homes "placed in financial distress as a result of the new mandates and fines"; and an extension of the time until the law takes effect. A nursing school professor told the newspaper that health insurance would make nursing home employees less likely to pass on infections to their patients and more likely to be treated when they have an occupational injury.

As a Philadelphia injury lawyer, I know those are both frequent problems for nursing home employees. According to the article, nursing home workers are injured twice as often as average, with many back injuries among those who help bed-bound and wheelchair-bound patients into and out of bed. And I've written here several times about the probability of sick employees spreading disease through a nursing home's closed population of vulnerable people. Often, workers come to work sick because they can't afford not to -- because, as the Times notes, the front-line workers make $10 to $12 an hour and frequently don't have adequate health insurance. Sometimes, a sick day for one staff member understaffs the home for the whole day, resulting in thin-stretched workers who are too busy to meet every patient's needs. This keeps costs low for employers, but in the long run, it poses risks that could be far more expensive -- including the risk of communicable disease, neglect and Pennsylvania nursing home abuse. As a Philadelphia medical malpractice lawyer, I hope nursing homes realize that insuring their workers can save money and lives in the long run, as well as being required by law.

Continue reading "Some Nursing Homes Want an Exemption From Employer Mandate in Health Care Reform" »

As a Philadelphia medical malpractice lawyer, I know that the spread of contagious disease is a major problem in nursing homes and hospitals. Contagious diseases are those that spread quickly from person to person, like the flu. Not surprisingly, they're a problem in every living situation where many people are clustered together -- but they're an especially big problem in nursing homes, where residents are more likely to be elderly and unwell. Now, a new study from the University of Pittsburgh has found that about 15% of nursing homes across the U.S. are cited for problems in their infection control practices each year. The study drew from records of citations used by evaluators considering homes for Medicare or Medicaid certification, which almost every home must have.

Pitt's Graduate School of Public Health looked through publicly available deficiency citation records from the years 2000 to 2007. The records included 16,000 nursing homes, about 96% of all homes. The results were not encouraging. One in seven homes had some kind of citation for problems in their strategies for controlling infectious disease. 48.6% of those citations were at a level indicating potential for more than minimal harm to the patient. The authors also noticed an upward trend, meaning the problem is getting worse over time. In 2000, 12.87% of homes had a deficiency citation for disease control; that number was 17.31% in 2007. And the authors said the deficiency citations were strongly correlated with a low quality of care overall and low staffing levels for nurses' aides, registered nurses or licensed practical nurses. They suggested that staffing problems may make it tempting for caregivers to skip important infection control measures like adequate hand-washing.

I couldn't agree more. As a Pennsylvania nursing home lawyer, I know that research shows low staffing levels at nursing homes is correlated with increased abuse and neglect. And while poor infection control is not usually Pennsylvania nursing home abuse, it is most certainly a form of neglect. For older people who are ill enough to go to full-time assisted care, infectious diseases can be deadly. Things like the flu or gastroenteritis might send a healthy adult to bed for a few days, but the associated dehydration and other stresses on the body can put a nursing home patient in the hospital. And preventing infectious diseases is relatively simple: caregivers, food handlers and others must be vigilant about washing their hands; not come to work ill; and separate patients who are known to be infected. As a Philadelphia injury lawyer, I believe nursing homes should give their staffs the time to take these steps, even if that means hiring more people, because lives can be on the line.

Continue reading "Pittsburgh Nursing Home Study Finds 1 in 7 Homes Cited for Disease Practices" »

I've written here twice before about the abuse caught on camera at the Quadrangle nursing home in Haverford, outside Philadelphia. I've talked about the possibility of a lawsuit, from my perspective as a Philadelphia injury lawyer, as well as the possibility that the abuse may go beyond that suffered by patient Lois McCallister. So I was not surprised to see a May 4 report from the Delaware County Times saying that McCallister's daughter and son-in-law plan a lawsuit against the Quadrangle's parent company, Sunrise Senior Living. And I was interested to read about other allegations against the home, as well as some background information about the family's decisions and how they are dealing with the abuse, from the Philadelphia Inquirer on the same day.

Mary and Paul French, McCallister's daughter and son-in-law, moved McCallister from Pittsburgh to the Quadrangle after a lot of research. The Quadrangle was expensive -- $7,700 to $8,000 a month -- but offered the care they needed and was founded on Quaker principles. However, when McCallister was moved to the dementia ward, problems began right away. Her hearing aids went missing; insurance forms were never completed; and McCallister started to complain about people hitting her. When the home denied the allegations, the Frenches bought a "nanny cam" and hid it in the room. Only a few days later, they had a video of three employees hitting and tormenting McCallister, who was not permitted to put a shirt on.

The three employees are fired and criminally charged, and the home says their actions were an aberration. The state has moved to revoke the Quadrangle's license (pending an appeal), and the Inquirer said Haverford Township police have referred two other cases of possible abuse to state authorities. And last week, the family announced that it would sue Sunrise. The Times did not specify how much money the family will request, but their Pennsylvania nursing home lawyer said they hoped an expensive verdict or settlement would motivate the company to take abuse allegations seriously. For now, McCallister is living with the couple, who also have two teenaged daughters. They plan to add to their home to create extra space, and for now, Mary French is filling the role of caregiver.

This story is a good example of why families consider Pennsylvania nursing home abuse lawsuits even when there are also criminal and regulatory investigations. Prosecuting the three employees gets bad employees away from vulnerable patients, which is good, but it doesn't do much to the supervisors and parent company that allowed this behavior in the first place (and then failed to report it). Closing the Quadrangle may not hurt Sunrise much either, considering that it has 22 homes in Pennsylvania alone. But as a Philadelphia medical malpractice lawyer, I know a judgment of several million dollars, which is likely in this situation, would get any company's attention. It would also refund McCallister's family for more than two years of expensive care that is now suspect. For this family, which is now juggling full-time care of a dementia patient with raising children and working, it would provide some financial relief that can be used on an in-home caregiver or expand the size of the home. And it can provide some measure of compensation for McCallister's emotional trauma and the family's broken trust.

Continue reading "Family Announces Pennsylvania Nursing Home Abuse Lawsuit Against Quadrangle" »

Last month, I wrote here as a Pennsylvania nursing home lawyer about the arrests of three former employees of a nursing home in Delaware County, near Philadelphia. The three women, ages 19 to 22, were caught on tape hitting and tormenting a 78-year-old patient with dementia. The tape came from a hidden camera placed in the room by the family of Lois McCallister, after nursing home officials dismissed the family's concerns about McCallister's bruises and complaints. Samirah Traynham, Tyrina Griffin and Ayesha Mohammed are all facing criminal charges and have been fired from the Quadrangle nursing home in Haverford. But more bad news for the Quadrangle came April 29, when the state Department of Public Welfare revoked the home's license for "gross incompetence, negligence and misconduct on the part of officials."

According to an April 30 article from the Philadelphia Inquirer, the state's problems with the Quadrangle go beyond McCallister's case. A report released by the DPW found that the Quadrangle failed to report abuse allegations and police investigations to the state; failed to conduct criminal background checks on employees in a timely manner; and made no effort to return lost valuables to patients, including eyeglasses. It also found medication problems: no doctor's orders were found for two patients' medicines, and another patient was not given prescribed medicine when needed. The Quadrangle last got in trouble two years ago, when a dementia patient drank antibacterial cleaner and another consumed paint, but it was given a full license last December. The current action means the Quadrangle may have to close if its appeal is not successful. The home's parent company, Sunrise Senior Living, voluntarily closed five other Pennsylvania nursing homes last year after regulatory compliance problems.

As a Philadelphia injury lawyer, I'm glad the state is taking action. Clearly, the behavior of the three fired employees is unacceptable Pennsylvania nursing home abuse, and was probably not sanctioned by the management. The question is whether their behavior grew out of negligent oversight by the Quadrangle's management, and the DPW's report suggests yes. Working with elderly dementia patients is an important responsibility, which is why Pennsylvania requires criminal background checks and regular inspections. Failure to conduct those background checks quickly enough -- to pick one example from the DPW's citation -- suggests that management does the bare minimum to comply with the law. Failing to administer needed medications or return lost eyeglasses may not even meet the bare minimum. None of this behavior suggests respect for these patients as people. As a Philadelphia medical malpractice lawyer, I hope the Quadrangle's appeal gives the state a chance to air these issues publicly, so regulators and families can decide for themselves whether this is a safe place for our community's most vulnerable adults.

Continue reading "Pennsylvania Nursing Home License Revoked After Employees Caught Abusing Woman" »

As a Philadelphia medical malpractice lawyer, I know medication errors are a major source of medical mistakes for patients of all ages. But I was disappointed to see an April 20 article about federal data showing that the majority of all medication error victims who wind up in the hospital are seniors. The data comes from the federal Agency for Healthcare Research and Quality, part of the Department of Health and Human Services. That agency found that medication errors have grown by 52 percent between 2004 and 2008, the last year it studied. That's 1.9 million people injured badly enough to need hospitalization, up from 1.2 people injured in 2004. Another 838,000 patients were treated in emergency rooms and released, 18 percent of whom were 65 or older.

The medication errors included errors patients made themselves and mistakes by caregivers providing the medicines. Reasons included overdoses, mistakes by pharmacists, bad reactions, mixing incompatible medications and more. The kind of drug that most often sent people to the hospital was corticosteroids, a class of drugs used to treat arthritis, asthma, inflammatory bowel disease and several other conditions. That class of drugs was responsible for 283,700 hospitalizations. Next most common were painkillers (269,400 cases), blood thinners (218,800), cancer and immune-system drugs (234,300) and heart and blood pressure medications (191,300). In emergency rooms, visitors most often didn't specify a drug, but also cited painkillers, antibiotics, tranquilizers and antidepressants, and corticosteroids.

This news concerns me as a Pennsylvania nursing home lawyer because people in nursing homes are likely to have complicated medical needs. Families generally put their loved ones in nursing homes when their needs are too constant or complicated for the families to handle themselves. For the same reasons, nursing home patients are less likely to be able to notice a mistake with medicine or speak up when they do. At the same time, nursing home employees can make mistakes or even intentionally make an unauthorized change in medication. Even the best intentions can fall flat when nursing homes are understaffed, robbing employees of the time they need to make sure details are right. And in some cases, employees have perpetrated Pennsylvania nursing home abuse by stealing painkillers from patients for their own use, intentionally giving inappropriate sedatives or withholding medication to save money. In either case, it's unacceptable for an institution we trust with the care of vulnerable older loved ones. Families who find themselves in this position should talk to a Philadelphia injury lawyer right away.

Continue reading "Study Finds More Than Half of Those Hospitalized for Medication Errors Are Seniors" »

As a Philadelphia medical malpractice lawyer, I was interested to see a new study suggesting that hospitalized nursing home patients may need an advocate even more than previously thought. As HealthDay News reported April 18, a new study by Northwestern University has found that older people can suffer short-term memory loss when they go into the hospital. Researchers found a temporary reduction in cognition among one-third of the patients they studied as they were being discharged from the hospital, but a majority of those problems disappeared in a month. They cautioned the public that it's vital for seniors to have a family member or other advocate present on discharge, so vital medical instructions aren't forgotten or lost.

The researchers studied 200 people ages 70 or older who lived alone and didn't have any diagnosis of cognitive problems like dementia. On the day the patients were discharged, the team administered tests measuring their reading and writing skills, orientation, calculation and comprehension. The results showed problems with nearly one-third of the patients. A month later, the researchers administered the tests again. Of those whose earlier test results showed problems, 58 percent no longer had results showing reduced cognition. Lead author Dr. Lee Lindquist said this suggested that some seniors may be better off with help understanding and applying discharge instructions. That kind of help could reduce the need for more hospitalization in the future caused by confusion or missed instructions about things like medication.

As a Pennsylvania nursing home lawyer, I am particularly interested in this as it applies to nursing home care. Patients in nursing homes are supposed to have advocates already on staff -- aides and nurses who are in charge of medication, nutrition and other needs. But all too often, nursing homes fail their patients by mixing up instructions or neglecting important medical needs. To prevent this kind of Pennsylvania nursing home abuse, I believe it's important for families to stay involved -- at all times, but especially when a loved one is hospitalized. By advocating for their disabled relatives at a time when they may not be able to advocate for themselves, families can prevent neglect and abuse leading to more health problems or even death.

Continue reading "Study Finds Pennsylvania Nursing Home Patients Can Lose Memory When Hospitalized" »

It's fortunately rare that I find a local news story directly relevant to my practice as a Pennsylvania nursing home lawyer. But I'm sorry to say that news reports broke last week of an incident of abuse caught on camera at a nursing home in Haverford, in Delaware County. As the Philadelphia Inquirer reported April 8, three women have been fired from the Quadrangle nursing home and charged with crimes after being caught on tape hitting and tormenting patient Lois McCallister, 78. Samirah Traynham, 22, Tyrina Griffin, 21, and Ayesha Mohammed, 19, are all charged with aggravated assault, criminal conspiracy, harassment, neglect of a care-dependent person and more. The police and the state Department of Public Welfare are both investigating, and McCallister has been removed to the care of her daughter and son-in-law, Mary and Paul Franch.

The Franches planted a hidden camera in McCallister's room at the Quadrangle after McCallister told them she had been hit and slapped, then later showed them bruises. The home told the Franches that McCallister's dementia was likely the reason for the complaints. The camera told a different story. In one video, Traynham slaps and hits McCallister as she struggles to pull a shirt over her head. In another, all three employees mocked McCallister as she stands there, topless, and repeatedly prevent her from leaving the room when she tries. Griffin helps McCallister put her shirt on, but then she and another employee pull and slap at McCallister's ears, which are sensitive because she had hearing aids removed. Griffin shadow boxes at McCallister and Mohammed pokes her in the eye. Five minutes after the more recent video was taken, the Franches showed up for a visit. They said McCallister was agitated and asked "Why do they keep picking on me?"

The video, from ABC News:

As a Philadelphia injury lawyer, I wish I had an answer for Mrs. McCallister. However, it looks like this is not the first regulatory trouble for the Quadrangle. The home was issued a provisional license in May of 2009 after one dementia patient ingested paint and another antibacterial cleaner. The home was cited for failing to keep the hazardous materials out of patients' reach, failing to obtain medical care and failing to report the incidents to the DPW. Its for-profit parent company, Sunrise Senior Living, has had 25 citations from the DPW for its 18 Pennsylvania facilities since 2007. Frequently, this kind of Pennsylvania nursing home abuse and neglect stems from cost-cutting, which stretches staffers thin, encourages fast turnover and encourages the use of inexperienced or less well trained staff -- which may explain why McCallister's caretakers were ages 19 to 22. Saving money is an important part of a for-profit business, but as a Philadelphia medical malpractice lawyer, I know it can also cost the company a lot of money in the long run, when patients whose health and dignity were compromised file successful lawsuits.

Continue reading "Hidden Camera in Philadelphia Nursing Home Catches Employees Abusing Woman" »

As a Philadelphia injury lawyer, I believe the profit motive in for-profit nursing homes sometimes undermines those homes' commitment to good care. So I was disappointed to see an April 3 article from the Erie Times-News about an apparent trend toward Pennsylvania counties selling their nursing homes to private companies. According to the article, at least fiver Pennsylvania counties -- most in greater Philadelphia -- have sold homes or are exploring the idea. A committee connected to Erie County's County Council has recommended the sale of its county-run facilities as well. However, the idea has met with fierce opposition in Northampton County, where advocates for the Gracedale nursing home in Nazareth are concerned that proposed privatization could harm the elderly and sick residents.

Gracedale, which has 600 employees and 725 beds, is one of the biggest county-run nursing homes in Pennsylvania. County government officials there are soliciting bids from private companies, in part because the 1970s-era building needs $10 million in repairs and improvements. However, county residents are currently petitioning to put the sale to a vote. Nursing home sales in other counties have also generated controversy over issues like number of indigent patients the homes will serve and whether union contracts with the counties will still be honored. Officials in Cambria County said the Laurel Crest home there lost $9.2 million in two years, and the sale removed a financial liability from their budget. Erie County's two Pleasant View Manor homes aren't losing money, their administrator said, but a county committee recommended selling it for financial and competitive reasons.

I oppose this because, as a Philadelphia medical malpractice lawyer, I believe that county governments are better caretakers for the sick and vulnerable than for-profit nursing home companies. Of course, not all companies seeking to make a profit are willing to do it at the expense of patients, but serving the financial bottom line has effects that voters may not realize. For example, homes can save money by cutting staff members, especially skilled staff members. However, when the ratio of staff to patients is too low, and especially when staff members don't have the right training, they may be too busy to give patients the attention they need to handle difficult behavior, dehydration and bedsore prevention. As a result, important patient care can be neglected, eventually causing health problems or even Pennsylvania nursing home abuse. Understaffed, underskilled homes may also use psychiatric drugs instead of behavioral interventions -- a practice that can lead to unnecessary illness or injury. As a Pennsylvania nursing home lawyer, I believe protecting the vulnerable is part of government's job -- not a business to be sold when the budget is tight.

Continue reading "More County-Owned Pennsylvania Nursing Homes Under Threat of Privatization" »

I've written here several times before, from my perspective as a Philadelphia medical malpractice lawyer, about the use and overuse of atypical antipsychotics in nursing home patients. Although antipsychotics are not approved for use in controlling dementia symptoms, nursing home staff members use them for this purpose anyway because they believe it helps control difficult or violent behavior. However, research over the past few years has found that atypical antipsychotics -- the drugs most often used for this purpose -- increase risk of death in elderly and demented patients, which has led to a dramatic drop in their use. Now, a new study published in the Canadian Medical Association Journal finds that typical antipsychotics, which may be used as an alternative, are no better.

The study was conducted using nursing home records for 10,900 patients in British Columbia. Scientists looked at all psychotropic drugs for patients 65 and older admitted to nursing homes between 1996 and 2006. That included roughly equal proportions of patients getting atypical and typical antipsychotics, as well as even more patients receiving antidepressants or benzodiazepines. After looking at outcomes for each class of patients, the researchers concluded that there was actually a lower risk of death for users of atypical antipsychotics than for patients in the other three categories. A geriatric psychiatrist from the University of Rochester, who was not connected to the study, said it was well designed, but more research was needed before doctors should change their prescribing practices.

As a Pennsylvania nursing home lawyer, I'm disturbed by these conclusions, because they suggest that no psychiatric drug is especially safe. Use of atypical antipsychotics has dropped since they got a black box warning about death, but it looks as if the clearest alternatives, older antipsychotics, carry at least an equal risk. That's unfortunate because nursing homes frequently use them -- in my opinion as a Pennsylvania injury lawyer, overuse them. Using drugs to control dementia patients' behavior may be tempting, especially for homes that have cut staff to save money and don't have the resources to handle difficult patients. However, these "chemical restraints" also leave them in a drugged state and puts them at risk of death and serious illness. I believe this is a form of Pennsylvania nursing home abuse, and families that have suffered an injury as result should hold them legally responsible.

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One of the most high-profile and saddening things I do as a Pennsylvania nursing home lawyer is representing victims of physical abuse and their families. Pennsylvania nursing home abuse encompasses more than just hitting, but physical violence does happen, and it's completely inexcusable. Such an incident apparently occurred Feb. 7 in Washington County, Penn., outside Pittsburgh. According to a March 16 article in the Pittsburgh Post-Gazette, 34-year-old Michael Ashmore, an employee at the Washington County Health Center, is accused of snapping a towel in the face of a 93-year-old resident, and attempting to punch and choke the man.

Few details about the incident were available. According to the article, Ashmore is charged by Chartiers Township police with simple assault, neglecting to care for a dependent person and making terroristic threats. He has been fired from his job at the state-run home as well. Though the incident occurred in early February, reports of the arrest and charges began surfacing March 15. The Post-Gazette said officials at the home waited to report the incident until after they had finished an internal investigation. All three of the charges are misdemeanors, and Ashmore could face a wide range of penalties, including jail or prison time. However, the incident also likely means Ashmore will be ineligible to work with nursing home or dependent patients in the future.

As a Philadelphia medical malpractice lawyer, I hope that's the case. Pennsylvania nursing homes are supposed to do criminal background checks on all new employees, and decline to hire people with certain convictions in their past. However, as a recent federal study showed, nursing homes across the nation have still employed people with criminal convictions that should have disqualified them. There are many reasons for this: incomplete databases, no state law requiring a background check and allowing employees to start work before the background check comes through. Unfortunately, some homes even intentionally ignore or sidestep the background check requirements, irresponsibly letting inappropriate people loose to abuse or neglect vulnerable sick or elderly people. When homes hire people they knew or should have known were unqualified as caregivers, they leave themselves liable in lawsuits by injured patients and their families.

Continue reading "Western Pennsylvania Man Accused of Physical Abuse of Nursing Home Resident" »