PENNSYLVANIA NURSING HOME ABUSE ATTORNEY BLOG

Articles Posted in nursing home neglect

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Often with aging comes the necessary need of daily medications to help control pain, cholesterol, blood pressure, and other ailments. In nursing homes across Pennsylvania and New Jersey strict maintenance and dispensing procedures of patient medication is key to both the patient’s ailments and survival. In some cases the pain medication has attracted unscrupulous characters that take advantage of elder patients often robbing them for their pain medication. Withholding medication from a nursing home resident can amount to nursing home abuse. Chronic pain is both under treated and a common ailment according to a recent study published by the Archives of Gerontology and Geriatrics. The study made up of 105 nursing home patients with the mean age of 82, living in two separate nursing homes in Torino, Italy, found that chronic pain was wide spread. The study suggests that chronic pain was present in 82.9 percent of the sample of patients studied, and that persistent pain lasting more than 24 months was present in half of the residents. Chronic pain can affect every part of a resident’s daily life. From their mood, nutrition consumption, sleep pattern, and overall quality of life, chronic pain can play a direct role in making a resident’s life enjoyable. That is why instances of prescription theft are particularly disheartening in the nursing home setting.

Many of those who work in nursing homes who steal prescription medication from residents are caught and prosecuted, as was the case for a former nurse at North Muskegon senior care facility in Missouri. Former registered nurse Ruth Ellen Everett unknowingly was under investigation by local police as she worked at Hillcrest Nursing Center in North Muskegon. As reported by MLive News affiliate, Everett was arrested on charges of elder abuse and larceny in connection with stolen morphine from a patient at the senior care facility on Monday, April 28. Unfortunately many residents are unaware that their medication has been tampered with and therefore are unable to press charges. Prescription theft in a nursing home or extended care setting can be slow and steady process leaving the victim often helpless and disoriented or writhing in pain. If you or a loved one is in a nursing home or being cared by another it is important to note what medications the resident has been prescribed. In some instances when a medication is stolen by a care provider the doctor may assume that the medication is not working and change the dosage. In some instances lethargy, weight loss, and anti-social behavior may result. If you are advocating on behalf of a loved one feel free to ask more information regarding medication tracking and rules over who and how medications are doled out in your specific nursing home or special care facility.
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I have spoken extensively about nursing home arbitration clauses often placed within nursing home admission papers. An arbitration clause has the power to dictate which causes of action can go before a jury and which must go through arbitration, a more discrete out of public view dispute resolution option. Arbitration agreements are construed according to contract law, requiring a valid offer, acceptance, and consideration. The recent case brought before the Pennsylvania Court of Common Pleas, Tyler v. Kindred Healthcare Operating, the court overturned the defendant’s preliminary objections to plaintiff’s wrongful death and survival complaint. The court held that the meeting of the minds could not be established when the decedent signed her admission papers for admittance into Kindred Healthcare nursing home. Further finding that the decedent’s daughter was also unable to act as the decedent’s power of attorney as the decedent had not given away any rights nor did the decedent authorize any family member to make any legal decisions on her behalf.

In Tyler v. Kindred Healthcare Operating, plaintiff Avenia Tyler brought a wrongful death and survival action against two nursing homes, Kindred Healthcare Operating, Inc. (“Kindred”), and St. Francis County House (“St. Francis”). Plaintiff alleged that decedent Ruth McNear, had developed necrosis, advanced pressure sores on her right lower extremity, and a second fracture to her right femur which required surgery. Plaintiff further stated that Ruth McNear had passed away due to complications from the second leg fracture and subsequent surgery. At the time decedent’s death, McNear was in complete control and care of defendants. When proper care is taken bedsores should not be present in residents of nursing homes. Part of care plans for residents that have limited mobility is a reposition of the resident approximately every 2 hours. If repositioning continues to be overlooked or ignored, often as a means to save limited time in understaffed facilities, a resident can suffer bedsores, urinary tract infection, and even a wrongful death. As part of the Federal Nursing Home Reform Act of 1987, all nursing homes that receive federal funding are required to have “sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” Bedsores are the most common form of negligent care given in nursing homes. It takes time and pressure for a bedsore to begin to form and even more time for the pressure wound to become infected.

Ultimately the court held that the arbitration clause could not be enforced as the decedent was not competent at the time of signing and therefore there was no meeting of the minds when the contract was executed. Medical records note at the time of signature decedent was disoriented and her thoughts were cloudy. While a resident at the nursing homes, nurses noted that decedent was both confused and impaired. St. Francis the second nursing home for the deceased Ruth McNear wanted to enforce the arbitration clause despite the late McNear state of confusion. The court held that the decedent’s daughter could not act as her mother’s agent simply because there is a familial relationship. Instead, the court held that the decedent would have had to given Lynette, her daughter power of attorney or at the very least the authority to make legal decisions on her late mother’s behalf. Accordingly, the court held in favor for the plaintiff finding that the survival action could not be severed from the wrongful death action.
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Because I practice nursing home abuse law in Pennsylvania, I was interested to see that publicly owned nursing homes are rapidly dwindling in our state. According to the Pocono Record, Monroe County’s government is considering selling its publicly owned Pleasant Valley Manor, in part because it’s running at a loss. To the west, Franklin County is already in the process of selling its nursing home, Falling Spring Nursing and Rehabilitation Center. One Monroe County Commissioner, Charlie Garris, noted that the trend in Pennsylvania counties is increasingly toward selling county-owned homes. But residents of both counties expressed concerns about the quality of care in the homes as they transitioned from public, nonprofit ownership to private, for-profit ownership. The news comes on the heels of an announcement from the Catholic Archdiocese of Philadelphia that it will sell several nursing homes in greater Philadelphia.

In Monroe County, the commissioners are considering a sale because the home is losing money. Pleasant Valley Manor lost $940,000 in 2012 and had already lost the same amount in the first six months of 2013. Garris noted that a supplier of food to the home once withheld its deliveries until it got paid, suggesting that the home’s administrators were behind on payment. The only commissioner to publicly oppose a sale is Suzanne McCool, who said the county has a moral obligation to take care of elderly and infirm residents. The article said “there’s a fear” that a for-profit home might not take indigent residents.

In Franklin County, Commissioner Robert Ziobrowski said county-run homes are no longer needed for indigent Pennsylvanians, because Americans can now rely on Medicare and Medicaid as well as private insurance. They have chosen two finalists from among the 10 private companies that offered to buy Falling Spring. But according to the local newspaper, Franklin County residents are concerned that private ownership will result in a drop in quality of care.

I share that concern. In my experience pursuing nursing home neglect lawsuits in eastern Pennsylvania, there is genuine cause for concern when nonprofit homes are sold to for-profit companies. As I noted in my blog post about the Catholic Church’s sale of homes, studies show that nonprofit homes do better on multiple measures of care, including staffing ratios, number of bedsores, citations from government regulators and more. Indeed, one study concluded that statistically, for-profit ownership leads to an additional 7,000 pressure sores a year. The difference may be attributed to things like attempting to get along with fewer employees or employees who are not well trained, both of which can lead to overwhelmed employees who cut corners or forget important tasks. Nursing home abuse is devastating and sometimes fatal; Pennsylvanians should think very carefully before doing anything that could lead to more of it.

Based in Philadelphia, Rosenbaum & Associates represents clients across eastern Pennsylvania who have suffered serious injuries from abuse or neglect at a nursing home.
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I’ve written here before as a Philadelphia medical malpractice lawyer about the onerous requirements in many states for filing a medical malpractice claim. Medical malpractice is a common assertion in cases of Pennsylvania nursing home abuse, but it’s so politicized that it’s much more difficult to file a medical negligence claim than it is to file a general negligence claim. Among other things, plaintiffs in many states, including Pennsylvania, must file an expert’s affidavit with the lawsuit to show that at least one expert believes the case has merit. A missing or inadequate affidavit is a reason for the dismissal of many medical malpractice lawsuits, and that was the problem in PM Management-Trinity NC v. Kumets, a Texas Supreme Court case that found an affidavit is needed even for a non-malpractice claim based on the same facts as the malpractice claim.

Yevgenia Kumets was admitted to a nursing home in Texas to recover from a stroke. While she was there, she suffered a second stroke. Some of her family believed that poor care she suffered at the home was responsible for the second stroke, though the opinion doesn’t detail their complaints. However, she was discharged from the home after the family complained about her treatment, leading the family to believe she was retaliated against. The Kumets family sued with claims for medical negligence, ordinary and gross negligence, negligence with employees, breach of fiduciary duty and contract, fraudulent billing, violations of the state Deceptive Trade Practices Act and retaliation, as authorized by a statute. They filed an expert report, but the court ruled it was deficient and an amended report didn’t cure the defects. The court dismissed all their claims except retaliation.

The two sides cross-appealed, arguing that various claims were or were not health care liability claims subject to the expert affidavit requirement. A divided Court of Appeals affirmed the ruling, saying a health care liability claim must involve “injury or death of the claimant,” and the retaliation claim asserted only economic loss.

The Texas Supreme Court reversed that decision, siding with the dissent in the Court of Appeals. The high court had previously held that any claim based on the same underlying facts as a health care liability claim is also a health care liability claim, and thus subject to the expert report requirement. As the court had noted in a prior case, 2010’sYamada v. Friend, Texas law does not permit plaintiffs to circumvent the expert report requirement through “artful pleading” or splitting claims. It noted that it was not holding that all retaliation or discrimination claims are health care liability claims, or even that the breach of fiduciary duty claim brought by the Kumetes is such a claim. But the Kumetses did not appeal the dismissal of that claim, the court said. It reversed the Court of Appeals and remanded with orders to dismiss the retaliation claim.

As a Pennsylvania nursing home lawyer, I think this ruling will not do any favors to Texas patients who have suffered serious injuries from abuse or neglect in a nursing home. The expert affidavit requirement is expensive and time-consuming at a time when victims are already facing a deadline and, often, high medical bills and relocation costs related to the underlying abuse. It also inappropriately shifts extra burdens to the plaintiff, because no expensive expert is required to certify that the defense’s arguments have merit. Applying it to claims that are not about medical malpractice makes it harder to recover fair compensation–and easier for nursing homes to continue providing shoddy care. As a Philadelphia injury lawyer, I don’t believe it’s good for anyone to protect bad nursing homes from consequences.
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Camay Williams brought a wrongful death and survival action against Willow Terrace and Albert Einstein Health Network on behalf o f Marcel Mackey, claiming that various healthcare workers were negligent in their care and treatment of Marcel.

Marcel was a very sickly man when he entered the care of these hospital providers in 2007 complaining of thirst and incontinence. He had a history of two above the knee amputations, diabetes, multiple strokes, dementia and various other maladies. While he was at the hospital he developed a pressure ulcer on his sacrum. When he was transferred to a long-term care hospital it was noted that there was an infection in the ulcer. Marcel was eventually transferred to Willow Terrace and had several brief admissions to Albert Einstein Medical Center (AEMC). The admission to AEMC noted dehydration, malnutrition, pneumonia, worsening of the ulcer, poor hygiene, and infections.

Marcel passed away a little over a year after his initial admission. His death certificate lists, among other things, severe end stage ulcer. Camay argued that substandard care, staffing, assessments, oversight, and administration, led to Marcel’s death.

The jury awarded Camay punitive damages in the amount of $500,000 finding that the facilities’ conduct was willful or wanton, or exhibited reckless indifference to the rights of the deceased. Punitive damages are meant to punish the defendant for outrageous conduct and serve as a deterrent to the defendant and others who may engage in similar conduct. The defendants in this case appealed the punitive damage award stating that the evidence presented fell short of the minimum required to warrant consideration of punitive damages.

Camay called several employees of Willow Terrance and AEMC to testify during the trial. The employees testified that Marcel was supposed to be repositioned every two hours and note it in his chart or his ulcer wound would worsen. There were portions of his chart, which were silent on repositioning, for example in the month of August there were 33 eight-hour shifts with no mention of repositioning. Multiple employees complained of chronic understaffing and testified that even with all staff present there were not enough employees to reposition all the patients every two hours. One nurse testified that Marcel’s ulcer was the size of a dinner plate and infected with a foul smell and puss drainage. Another nurse testified that when she changed the wound dressings it was clear that they had not been changed every shift as required. Further, nurses testified that incomplete chart entries revealed a lack of catheter care, showers and skin assessments. Willow Terrace also received numerous deficiencies from state inspectors.

Camay also called an expert who testified that the facilities were operating “woefully below the standard of care” and that they played a substantial role in Marcel’s death. Another expert testified that the failure to reposition played a large role in the deterioration of the ulcer and ultimately in his death.

The reviewing court upheld the lower court’s punitive damage award finding that the facilities acted in an outrageous fashion, in reckless disregard to the rights of their patients and created an unreasonable risk of physical harm to Marcel. The court relied heavily on the record of chronic understaffing and its resultant inability to care for patients.

Williams v. Willow Terrace, PICS Case No. 13-1208 (C.P. Philadelphia April 8, 2013) Jackson, J.

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When Pennsylvania nursing home abuse takes place, it often takes place behind closed doors. If the victim is a patient with disabilities that prevent clear communication, it may be some time before the abuse is uncovered. That’s why I was interested, as a Philadelphia injury lawyer, to see news out of Ohio that a long-term hidden camera investigation of one nursing home has led to revocation of the home’s license and possible criminal charges. The Columbus Dispatch reported that state officials recorded “shocking and disturbing” instances of abuse and neglect with hidden cameras at Autumn Health Care Nursing in Zanesville, Ohio. The local NBC affiliate added that the cameras revealed multiple kinds of neglect and falsified documents. The home has 60 days to shut down; the state is helping patients move to new facilities.

NBC reported that patients’ families’ complaints originally motivated the investigation. The state attorney general wouldn’t say how long the cameras were in place, but state regulators have been monitoring the nursing home for at least four years, in response to complaints. The cameras, installed with permission from patients and families, recorded neglect of at least one patient’s medical, nutritional and personal needs. Employees were accused of falsifying documents to make it look as if those needs had been met, the article said. Once the state health department had these results, it performed an inspection and found violations in patient treatment and care; infection control; food and nutrition; and resident rights. Families were upset that their loved ones were not given adequate care and that they had to move.

The state attorney general said criminal charges could be filed in the case, including possible charges of Medicare fraud, patient abuse, theft and falsification. The articles don’t say what exactly happened to these patients, and perhaps it’s for the best that the patients themselves and their families will have a chance to decide whether to go public. But as a Philadelphia medical malpractice lawyer, I suspect we’ll receive more details if any of the families involve decide to file lawsuits. Lawsuits are a real possibility because patients and their families often end up with steep medical bills from this kind of neglect. Malnutrition, dehydration and pressure sores can be serious threats to an immune-compromised elderly person, requiring hospitalization. The obligation to change facilities is also unlikely to be cheap. All of these costs are recoverable in Pennsylvania with a Pennsylvania nursing home abuse lawyer‘s help.
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Unfortunately, there are people who willingly take advantage of the elderly people in our lives. You may discover that an elderly member of your family has signed a document which appears to eliminate the possibility of bringing a claim for injuries they suffered. That was the case in Philadelphia, where the executor of the estate of Richard MacPherson sought to bring an action for the abuse and neglect Richard suffered while a resident at several hospitals and nursing home facilities.

The defendant health care facilities sought to introduce an arbitration agreement signed by Richard that would have forced his executor into arbitration and set the terms of the arbitration instead of being allowed to file a complaint in Common Pleas Court. The agreement Richard had signed required, among other things, that whoever lose in arbitration pay attorneys’ fees and costs, arbitration costs be divided equally, there be no jury trial and that there be a very limited right to appeal the arbitration decision.

The defendants relied on a case called Williams v. Penn Center Rehabilitation and Care, when they claimed that the executor could not file a case and must comply with the terms of the arbitration agreement. There, Mr. Williams testified during a deposition and stated that he understood the process and knew what he was signing when he signed it. In Richard’s case, however, he had lost more than twenty pounds in a matter of two months. He was incontinent and entirely reliant on facility staff. His body was covered in blisters, scar wounds, necrotic tissue and lesions. Richard also suffered from various medical maladies including chronic obstructive pulmonary disease, congestive heart failure, depression, Hepatitis C, diabetes and substance abuse. Richard had passed away before this case was filed and therefore could not testify at a deposition regarding his understanding of the arbitration agreement he had signed. Further, defendants’ representative who had presented the paperwork to him had no recollection of her conversation with Richard.

Agreements are found to be “procedurally unconscionable” and therefore void when there is a lack of meaningful choice by the weaker party in accepting the terms of the agreement. In finding that this agreement was indeed unconscionable and void the Court here relied on the fact that Richard had no ability to negotiate the terms of the agreement. He signed the agreement on the same day it was presented to him and would not have had an opportunity to review it or discuss it with an attorney or others.

Therefore, due to factors such as the degree of Richard’s illness, the fact that the agreement strongly favored the defendants, the inability to obtain testimony from Richard regarding his understanding of the agreement and Richard’s inability to negotiate the terms of the contract because of how quickly it was presented and signed, the Court found that the agreement was void and allowed the executor to move forward with his case. Depending on the circumstances surrounding an elderly person’s signing of a document it might not actually be binding.

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As a Pennsylvania nursing home lawyer, I’m very interested in the recent series of appeals court cases about whether a binding arbitration contract is valid. Very often, these cases go to trial because someone other than the patient, or his or her health care agent, signed the agreement. It’s not usually clear that the third party who signed the agreement had any authority to represent the patient’s legal interests, and when the patient, or his or her estate, later sues the nursing home, a court has to decide the issue. That was the case in GGNSC Omaha Oak Grove LLC v. Payich, in which the son of Nada Payich sued Golden Living Center of Sorensen. Ivan Payich signed the arbitration agreement when his mother was admitted, but Nada Payich had not been declared incompetent to manage her own affairs. A district court declined to compel arbitration, and the Eighth Circuit agreed.

Nada Payich executed a power of attorney on behalf of her son, Ivan Payich, on Sept. 3, 2009. The next day, Nada Payich was admitted to the Golden Living Center of Sorenson. No doctor had declared her incompetent. Nonetheless, Ivan signed the admission agreement on the line for Nada’s legal representative, and also signed an arbitration agreement, adding “son” after his signature. Unfortunately, Nada Payich died after her admission to Sorenson. The appeals court’s opinion doesn’t go into the details of how Sorenson allegedly neglected or abused her, but Ivan Payich’s later lawsuit alleges negligent care by the home that led to physical and mental injuries. After removing the case to federal court, Sorenson moved to compel arbitration, arguing that Ivan signed on Nada’s behalf and was therefore bound by the arbitration agreement, or that Nada was a third-party beneficiary to the agreement between Ivan and Sorenson. The district court disagreed.

The Eighth U.S. Circuit Court of Appeal upheld that decision, finding no valid agreement applied to Ivan’s lawsuit. On appeal, Sorenson argued only that Nada was a third-party beneficiary to an arbitration agreement between Ivan and Sorenson. Because Nada accepted the benefits of the agreement–care by Sorenson–her estate should be bound by them, the nursing home argued. The Eighth disagreed, saying there was no contract between Sorenson and Ivan, as required to find that someone is a third-party beneficiary. The arbitration agreement expressly names Nada as the contracting party, the court noted. It only provides signature lines for the patient herself or for her legal representative if she is incompetent. Though Ivan’s choice to put “(son)” after his signature suggests that he intended to sign as Nada’s representative, Sorenson abandoned the argument that he was acting as her representative. Thus, the Eighth upheld the ruling declining to compel arbitration.

As a Philadelphia injury lawyer, I approve. Arbitration agreements are not necessarily fatal to a Pennsylvania nursing home abuse case, but they’re not usually helpful. Arbitration shields the proceedings from public view, which keeps the public from learning about the details of abuse or neglect allegations. To make matters worse, some arbitrators have been accused of essentially deciding cases the way the nursing home–the party that brings in their paying business–prefers. This stacks the deck against the plaintiff–the injured patient and his or her family–and prevents them from warning the public. As a Philadelphia medical malpractice lawyer, I believe everyone has a right to their day in a public and publicly accountable court.
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In an unusual situation, an eastern Pennsylvania nursing home patient is being charged with a homicide in the death of another patient. As a Pennsylvania nursing home lawyer, I was interested to see that Carl Smith was arraigned on charges of involuntary manslaughter for pushing Margaret Lechleitner, 85. Both were residents of the dementia ward at Weatherwood Nursing Home in Weatherly, a Carbon County community between Allentown and Scranton. Lechleitner died after she fell to the floor, hit her head and suffered a subdural hematoma, a kind of blood blister. The death was ruled a homicide by the Luzerne County coroner–but the ruling only means that it was caused by another person, not that it was a criminal act. According to WNEP, medical experts and a judge will decide whether the case should go to trial.

The incident leading to Lechleitner’s death took place April 20. Smith told authorities that Lechleitner pushed him first and he pushed back, though police say there’s no evidence that she pushed him. After Lechleitner hit her head, she was taken to the Hazleton General Hospital just over the county line, where she died the next day. Police said they had to balance competing interests in the case, because Smith has dementia as well. An officer said the police wanted to make sure justice was served for Lechleitner’s family, but also that everyone around Smith is safe and that Smith continues to get treatment. An Alzheimer’s Association of Pennsylvania spokeswoman told WNEP that she has never seen an arrest, or indeed any situation where one dementia patient caused the death of another.

Interestingly, no one in the articles commented on the oversight responsibilities of the nursing home. Of course, there may have been nothing that nursing home attendants could do, if the incident happened quickly. But if Smith and Lechleitner were left together without supervision, the home may be vulnerable to a Pennsylvania nursing home abuse lawsuit alleging that it was negligent. Dementia patients end up in nursing homes because they need the kind of 24-hour supervision that families often can’t provide. In fact, in nursing homes, they are known for having difficult behavior. Nursing home staffs are supposed to keep them out of trouble, but as a Philadelphia medical malpractice lawyer, I know understaffed, stretched-thin homes let things slide sometimes–and patients can die or suffer injuries as a result.
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The Administrative Office of Pennsylvania Courts (AOPC ) announced the establishment of the Elder Law Task Force formed by the Pennsylvania Supreme Court to investigate the increasing troubles regarding abuse, neglect, guardianship and the access senior citizens have to justice. Justice Debra Todd is chairing the task force, which will recommend possible legislation, amended laws, training and best practices. The task force has one year to finalize their study.

Supreme Court Chief Justice Ronald Castille said that Pennsylvania’s older population has significantly increased and as it grows, it is straining the ability of courts to provide services to protect elderly Pennsylvanians. He further stated that the requirements of the elderly will last for years, especially with regard to elder abuse, guardianships and their access to legal recourse. He said that it is time to guarantee that older Pennsylvania citizens will not suffer abuse or the loss of their savings.

Justice Todd has said that our society focuses on child abuse, but rarely addresses the abuse of the elderly. The force is hoping to put new laws into effect before the elderly population swells even more because with more elderly citizens comes more elderly abuse. Nowadays the number of people in the United States who are over 65 years old is greater numerically and proportionately than it has ever been, according to the U.S. Census Bureau. Pennsylvania is only exceeded by three other states in terms of elderly population density.

The AOPC gave three instances of elder abuse that would be addressed by the task force. One example was a 64-year-old man from Lancaster who relied on his personal care aide to fix his meals, bathe and dress him because he only had one leg. The police said that the aide neglected the man so severely that the amputee developed skin ulcers that reached the entire way to the man’s bone. Due to the extensive wounds, he lost his other leg.

Another example dealt with a Bucks County woman enlisted a neighbor to handle her personal finances since she was entering a nursing home. The neighbor squandered her savings on casino trips, jewelry, posh vacations and golf outings rather than paying her bills. The man has been charged with five felony theft charges.

The National Institute of Justice recently funded a study that reported that in 2009 eleven percent of folks over the age of 60 were the victims of senior abuse. Justice Todd said that at least the two previous cases had been reported. Todd said the U.S. Administration of Aging’s National Center on Elder Abuse reported recently that for every one reported case, it’s estimated that there are five unreported cases. Justice Todd called that statistic shameful and insisted that Pennsylvania can do a better job protecting seniors from abuse and neglect.