Articles Posted in nursing home abuse

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As a Pennsylvania nursing home lawyer, I was pleased to see that a Western Pennsylvania family has settled its Pennsylvania nursing home abuse lawsuit with a nursing home. According to the Altoona Mirror, Affinity Health Services Inc. settled claims that a worker there assaulted a 77-year-old woman two weeks before her death. Christine Welshans was left with bruises and blood on her face after the alleged assault on Aug. 16 or 17 of 2009. The aide accused of hurting Welshans was also accused of assaulting another patient, but the case involving Welshans was closed after her death two weeks later was ruled heart-related. The family’s lawsuit noted that the aide, not named in the article, had a history of abusing patients at another home.

Welshans had physical problems, but was pleasant and able to interact with staff until the night of Aug. 16 or the early morning of Aug. 17. That’s when the lawsuit alleges she was battered around the face by the aide. A city police report the next day said Welshans had bruising around her eye, her cheek and her chin, and dried blood on her cheek. After the incident, she was agitated and claimed someone had hit her. There was no witness to the attack, but a witness did see the other attack that night, in which the aide pinned a woman’s arms to her body using the belt on a robe. Though that incident led to charges, they were dismissed at a preliminary hearing. The lawsuit claimed Affinity was negligent in hiring the aide with the history of violence.

As a Philadelphia injury lawyer, I’d like to know what happened to the aide–who, let us remember, assaulted the other patient in front of witnesses. The article didn’t mention whether the aide was disciplined by the state or the company for the assault on the other patient, or for the allegations involving Welshans. It does mention that the law enforcement officer who gave the aide a voice stress test after the incident thought he or she was lying, which was probably important in court. If the aide was not fired after these incidents, Affinity will have a lot of questions to answer–especially if he or she assaults more patients. For-profit nursing homes don’t like to lose staff because replacing them costs money, but keeping this kind of employee puts patients in danger. As a Philadelphia medical malpractice lawyer, I hope Affinity did the right thing with this aide.
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As a Pennsylvania nursing home lawyer, I was disappointed to see another case of a hidden camera turning up serious Pennsylvania nursing home abuse. NBC10 Philadelphia reported on an abuse case that was uncovered at a nursing home in Bucks County. Two former employees at the Arbors at Buck Run were caught on camera dumping a wheelchair-bound woman onto a bed, singing and yelling directly into her face. Regina Battles, 20, and Irene Rodriguez, 22, have since been fired and are in county jail on charges of neglect of a care-dependent person, reckless endangerment, harassment and assault. The home has been issued a shutdown order by the Pennsylvania Department of Public Welfare, but it’s appealing that order and will remain open for 30 days.

The Philadelphia Inquirer reported that the victim’s daughter planted a hidden camera in the room because she suspected mistreatment of her 83-year-old mother, an Alzheimer’s patient. On three consecutive days in October, the camera caught Battles and Rodriguez handling the victim roughly as they helped her into and out of bed. For example, the videos show Battles grabbing and pulling or pushing the woman’s legs roughly; and both workers placing her on the floor before shoving her into bed. Another video shows the victim falling out of bed with no help coming and no preventive measures. The woman can clearly be seen crying in some videos and was caught another time covering her face in fear. The victim was taken to the hospital in November with minor wounds to her legs and feet, and is now living at another home.

The Arbors at Bucks Run, a private for-profit home, immediately fired both employees after the family complained to the state. However, the complaints triggered a state inspection Dec. 3 and revoked the home’s operating license Dec. 7. The Inquirer said the action was a penalty for hiring Rodriguez and Battles before finishing background checks; PhillyBurbs.com cited gross incompetence, negligence and misconduct. The home may continue operating while it appeals.

As a Philadelphia medical malpractice lawyer, I look forward to hearing more about this case. It has several similarities with the 2011 case involving the Quadrangle nursing home, in which a dementia patient’s daughter confirmed suspicions of abuse with a hidden camera. That family went on to file a lawsuit against the home, and the employees caught on camera were criminally charged for their part. The employees in this case have a defense attorney who believes their actions were misinterpreted, but as a Philadelphia injury lawyer, I suspect the videos will speak for themselves when it’s time to go before a jury. But more importantly, I hope the regulatory action taken against this home results in long-term improvements in patient safety.
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The Pennsylvania nursing home neglect and abuse attorneys here at Rosenbaum & Associates often hear about some awful and depraved acts. These horror stories strengthen our resolve to ensure justice and maximize safety for our clients. Unfortunately, many nursing home abuse victims lack perspective about just how pernicious and disgusting these crimes can be; as a result, they may fail to take swift and effective action to stop them.

Consider, for instance, recent accusations against employees at a nursing home called Envoy of Staunton. The situation at this nursing home is, to put it mildly, disgraceful.

Consider these points:

• One employee, 47-year-old Anthony Johnson, faces both criminal and civil charges in connection with accusations that he groped a 53-year-old patient and compelled a 43-year-old patient to have oral sex with him. One of the family members of the victims finally reported Johnson’s actions to the police. Envoy finally fired the nurse’s aide, but that punitive action obviously cannot undo the damage done to the assaulted patients.
• Meanwhile, Diane Renee Kline, a 41-year-old administrator and RN, stands accused of failing to report exploitation/abuse to Adult Protective Services. This may not seem to be as “serious” as the crimes that Johnson allegedly committed, but when nursing home watch dogs fail, the system basically collapses;
• 69-year-old Charles Williams, another Envoy employee, stands accused of penetrating a 71-year-old woman with an animate object. In that case, the nursing home immediately contacted police, but still… it does not speak well of a facility when multiple disgusting events occur.

An inspection of this nursing home exposed ten different deficiencies in areas as diverse as food safety, medication management, care and services, and infection control.

The crime of nursing home sexual assault in Philadelphia or elsewhere is grim and terrifying. Some victims may be too terrified to come forward to authorities or even to family members. Others may be too sick or cognitively impaired to report the abuse or even understand what’s happening.

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As a firm that’s very active in Pennsylvania nursing home abuse and neglect law, Rosenbaum & Associates pays close attention to the relevant machinations going on in Harrisburg.

As readers of this blog might remember, last fall, the Pennsylvania House passed a bill supported by associations like Pennsylvania Health Care Association/Center for Assisted Living Management. The bill aimed to limit punitive damages that liable nursing homes would have to pay in certain cases. Damages would be limited to double compensatory damages (at best), with an exception for situations in which intentional misconduct occurred.

The bill would also compel plaintiffs to file in the county in which the abuse/negligence happened — as opposed to in counties that have a reputation for being more favorable to plaintiffs.

The Nursing Home Associations’ push may have stalled out for now, but analysts believe that the effort could be kick started again in the fall.

Advocates of the legislation cite the fact that Pennsylvania’s malpractice insurers paid out nearly $320 million in 2011, according to National Practitioner Data Bank research. That would make Pennsylvania the second biggest medical malpractice payout state – ahead of New Jersey and Illinois, but significantly short of New York’s numbers (a $680 million payout!)

The Nursing Home Association has also complained that nursing facilities often operate on small margins; and these fragile businesses could lose everything in a single massive lawsuit. Advocates of the bill also point to massive, almost cartoon-like judgments in places like Florida, where two state facilities last year got hit with judgments of $200 million and $900 million, respectively.

What advocates of this Pennsylvania Nursing Home legislation are not paying attention to…

It’s true that abuse/neglect lawsuits and settlements can place a burden on facilities. But isn’t that burden a good thing? If you or someone you love got hurt in a PA nursing home due to a prescription medication foul-up, bedsore metastasizing into life threatening sepsis, or other horrific scenario, wouldn’t you want to be able to leverage a full suite of legal tools to get compensated and to take care of your loved one?

Is our current system always totally fair? No.

But it’s more unfair to victims of abuse or neglect than it is to owners of negligent facilities – by a long shot.

Perhaps if advocacy groups like the Pennsylvania Health Care Association/Center for Assisted Living Management spent more time identifying best practices for senior care — and punishing facilities for straying from a high standard — there would be less need for law firms and less need for the kind of legal actions that these groups rail against.

The horror stories that we’ve personally heard – and have helped to abate – along with compelling statistics at both the national and state levels suggest that the onus is on delinquent nursing facilities. These facilities need to do a better job of taking care of people: of fulfilling their fiduciary responsibilities not only to their patients but also to our communities.
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As a Pennsylvania nursing home abuse attorney, I was shocked and saddened to read about the tragedy of Rachel Holliday, an 84 year old patient at a Chapel Hill nursing home, who passed away after being horribly abused. She allegedly got sick after being doped with morphine by a nurse who apparently didn’t want to be bothered to care for her patients.

Nurse Angela Almore was sentenced last Monday to five months behind bars and two and a half years of probation as part of a plea deal she made with prosecutors. The allegations against Almore were all too familiar to anyone who has studied the nursing home abuse case literature. Nurse Almore had been on duty at Britthaven Nursing Home in Chapel Hill, North Carolina, on February 13 and February 14, 2010. On Valentine’s Day evening, Holliday started suffering respiratory distress; and she had to be rushed to UNC Hospitals for treatment.

Doctors at first couldn’t figure out what was wrong with her. They eventually realized that there were opiates in her system. This was confusing, since she had not been prescribed opiates.

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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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As a Pennsylvania nursing home lawyer, I was interested to see a record-setting verdict in a Florida case involving serious neglect of a 92-year-old woman. According to the Tampa Bay Times, a jury in Tampa Bay has awarded $200 million to Richard Nunziata, the adult son of Elvira Nunziata, who died in 2004 when she fell down a staircase while strapped into a wheelchair. Nunziata was in the early stages of dementia and prone to wandering; the nursing home was supposed to have alarms on the door, her clothing and the wheelchair. But the employees at the home reportedly disabled the alarm so they could take frequent smoking breaks, according to the newspaper. Unusually, the nursing home company did not defend itself, in part because its several related business entities had gone out of business.

Nunziata was a resident at Pinellas Park Care and Rehab Center in St. Petersburg. One afternoon, she disappeared from a group of residents, and an hour passed before staff members noticed. When they checked the emergency exit door, they found her at the bottom of a staircase, her bloody body still strapped to the wheelchair. She died just after paramedics arrived. The Pinellas Park nursing home had a history of deficiency citations and abuse complaints, according to the newspaper. At trial, former employees testified that the home was frequently understaffed and that the door alarm was routinely disabled by smokers. They also told the jury that Nunziata had fallen before and was known to wander. The jury award for $60 million in compensatory damages and $140 million in punitive damages is believed among the largest in the state of Florida.

The for-profit nursing home’s management company, Trans Health Management Inc., did not defend itself in court; its parent company is in a receivership in Maryland. An attorney representing Trans Health filed unsuccessfully to stop the trial three days before it was scheduled to begin. However, the Tampa Bay Times noted Feb. 5 that collecting on the judgment may be difficult. That’s because the assets and liabilities of the nursing home have been separated into a set of companies — many using the same phone number and office building as Trans Health — whose legal relationships will have to be sorted out in court. In fact, the company that inherited the liabilities has disappeared without filing tax returns, the newspaper said. The nursing home abuse attorneys for Nunziata’s estate said these companies existed only to strip away assets and protect the defendants from liability, and the real owners are a series of private investors.

This kind of corporate shell game is not unknown to Philadelphia injury lawyers like me. For-profit nursing homes are increasingly using corporate law to shield themselves from the consequences of their own negligence. To collect on a Pennsylvania nursing home abuse verdict, plaintiffs frequently must do some detective work — the Nunzata case involved testimony from a forensic accountant — and pursue entities that may be far away from the home in question. As the newspaper noted, even the federal General Accounting Office could not determine which of the corporate entities attached to the six biggest nursing home chains were in charge of what. As a Philadelphia medical malpractice lawyer, I oppose this because it prevents injured families like Nunziata’s from collecting on debts they are legally owed — debts ordered by a court after a fair trial.
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As a Pennsylvania nursing home lawyer, I was very interested in a bill that recently became law in Harrisburg. The Long-Term Care Nursing Facility Independent Informal Dispute Resolution Act will establish a new process for Pennsylvania nursing homes facing regulatory penalties after state regulators’ inspections or responses to complaints. A press release from State Rep. Mauree Gingrich of Lebanon said the process will give long-term care facilities the option of using the current regulatory process through the state Department of Health, or choosing an outside reviewer at their own expense. The bill was hailed by state legislators including Gingrich for its potential to save money for nursing homes. It was passed in the state House Dec. 16 and signed Dec. 22, with an effective date of April 1, 2012.

Under the act, nursing homes now have the option of bypassing the current review process when they are found out of compliance with a state safety regulation. They may still use that process, but they may also hire a private Quality Improvement Organization at their own expense. Legislators said this would permit nursing homes with compliance problems to dispute inspectors’ findings before those findings are entered into federal systems that collect nursing home quality data. This, in turn, would permit homes to avoid litigation and thus save money. Proponents emphasized that the new system would still ensure quality of care for nursing home residents. Opponents of the bill, including organizations that advocate for the elderly, asked legislators to add provisions allowing patients and their families to have a voice during this process.

Cutting off patient access to the review process is concerning — but as a Philadelphia injury lawyer, I am concerned about other aspects of this bill as well. Allowing nursing homes with safety problems to choose an outside inspector creates an opportunity for nursing homes to essentially buy the regulation they prefer, by choosing QIOs that are willing to provide whatever answer the nursing homes like. It will slow down the process of fixing any underlying problems, because it permits homes to delay their response while they go through the QIO process. The references to keeping homes’ violations out of federal records are also disturbing. Using correct and current federal records is a great way for patients to avoid homes with a record of Pennsylvania nursing home abuse, so it’s better to include every violation on record. As a Philadelphia medical malpractice lawyer, I hope patient advocates are following this law closely.
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As a Pennsylvania nursing home lawyer, I was saddened but not surprised to read a new report detailing how many cases of elder abuse and Pennsylvania nursing home abuse often fall through the cracks. The investigative journalism organization ProPublica published a report Dec. 21 on the rarity of investigations into suspicious deaths of elderly Americans. According to the article, part of the problem is that older people’s deaths are not unusual, and therefore not given the scrutiny that would be given to a younger person’s death. Coroners may assume that older people died of natural causes without looking into it, especially with nursing home patients. However, the investigators found that coroners are under-funded and rely too heavily on doctors’ reports on death certificates. In many states, doctors may sign death certificates without viewing the body, allowing nursing homes to cover up the true reason for a death even when a casual glance at the body reveals it.

That was the case in the death of William Neff, who died at 83 while he was in an assisted living home in Bucks County, Pennsylvania. When he died, the home told its doctor that “failure to thrive” due to dementia was the cause, and that’s what the doctor put on the death certificate. But when Neff’s relatives moved his body to a funeral home, the director preparing Neff’s body for burial noticed broken ribs and a 16-inch bruise on one side. Rather than continuing preparations, the director contacted the Bucks County coroner’s office, which determined that Neff died of a lung puncture caused by one of five broken ribs, caused by some kind of violent impact. A criminal investigation of the home eventually revealed that Neff was beaten to death by home employee Heidi Tenzer, who was later convicted of third-degree murder. Three other employees were convicted of related crimes. In other cases profiled in the article, homes used natural causes to cover up the effects of neglect, including deep, severe bedsores; misuse of antipsychotic drugs; dehydration; infections; and disease.

As a Philadelphia medical malpractice lawyer, I know any of those conditions would raise serious questions about the nursing home’s quality of care and safety. Pressure sores in particular (also known as bedsores) are a serious issue because they require frequent attention and go unattended far more often than they should. The abuse described at the Bucks County nursing home is even more troubling because there’s no way that Neff’s abuse could be attributed to mistakes or overwork; he was literally beaten to death. To make matters worse, the article reports that Neff had speech problems because of his Alzheimer’s, meaning he likely couldn’t speak up about any previous abuse. The case resulted in several criminal prosecutions. As a Philadelphia injury lawyer, I hope it also sparked a state investigation into the quality of that home’s care, in order to protect other vulnerable residents — and close scrutiny by the families of other residents.
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I’ve written here many times about the overuse of antipsychotic medications among nursing home patients. These are typically prescribed for control of dementia patients with unpleasant behaviors like aggression, which is an off-label use not approved by the Food and Drug Administration. The practice has long been under fire by Philadelphia medical malpractice lawyers because of the drugs’ tendency to sedate the patients into insensibility. The drugs also sometimes carry dangerous side effects; eight atypical antipsychotics recently got a warning that they may actually raise the risk of death in elderly patients. So I was interested to read an article suggesting that the Centers for Medicare and Medicaid, a federal agency that oversees those two programs, has proposed penalizing homes that overuse the drugs.

The proposal came in testimony from the Office of the Inspector General of the Department of Health and Human Services, which oversees CMS. The Inspector General, Daniel Levinson, authored a companion study that found a very high rate of erroneous Medicare claims for antipsychotics to treat dementia, that most antipsychotics are used for that purpose in nursing homes and that 14 percent of all Medicare patients in nursing homes had antipsychotic claims. Levinson has publicly argued that this is too high, especially considering the risk of death for elderly people taking atypical antipsychotics. In testimony before Congress Nov. 30, Levinson suggested that HHS penalize facilities that use Medicare to fund improper use of antipsychotics; one penalty could be withholding Medicare payments. The report by the Inspector General’s office examined why Medicare Part D insurers don’t refuse to reimburse for this off-label use.

As a Philadelphia injury lawyer, I’m pleased that this issue is getting the attention it deserves. Nursing home attorneys have argued for years that the use of drugs as “chemical restraints” is a misuse of medication, which robs patients of their ability to enjoy life and carries financial costs and potentially damaging medical side effects. Indeed, someone else testified at that hearing that antipsychotics are now essentially replacing physical restraints, which have fallen out of favor in nursing homes. Both of these are a form of Pennsylvania nursing home abuse that patients and their families should not allow, given the considerable risks. Families that suffer injury, illness or abuse because of off-label antipsychotic use should consider whether they want to get in touch with a Pennsylvania nursing home lawyer.
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