Articles Posted in nursing home abuse

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Here in greater Philadelphia, we recently saw a case of Pennsylvania nursing home abuse exposed only because of a hidden camera. That patient is now living with her daughter’s family, and the family has filed a lawsuit against the home even as prosecutors pursue charges against the three employees involved. As a Philadelphia injury lawyer, I was interested to see a recent article in the Cleveland Plain Dealer about a similar hidden-camera situation uncovered abuse in an Ohio nursing home. According to the article, a former aide at the Prentiss Center for Skilled Nursing Care pleaded guilty this week to seven counts of abusing or neglecting a patient. Virgen Caraballo and other aides are accused of abusing and mocking Esther Piskor, 78, after they were caught on a hidden camera installed by her son. Caraballo and three others were fired, and the Piskor family is now suing the home.

Steve Piskor moved his mother into the Prentiss Center in 2009. He became concerned about the quality of her care after his daily visits sometimes found her sitting in a soiled wheelchair. He also found marks on her face. He filed four complaints with the home that led to no action, he said, so he installed a camera in the room that was visible to employees. Nursing home administrators permitted the employees to put a towel over that camera, so Piskor installed a hidden camera disguised as an air freshener and posted a sign on a bulletin board in her room notifying visitors about the camera. Within two days, he says, he had footage of employees throwing Esther Piskor into a wheelchair, pushing a hand into her face, spraying something into her face and other inappropriate behavior. He and his attorney brought the videos to police and nursing home administrators — though the administrators reportedly debated whether the behaviors constituted abuse. Esther Piskor has been moved to another home.

The family’s attorney said he suspects Esther Piskor was not the only victim, and as a Pennsylvania nursing home lawyer, I suspect he’s right. Often, this kind of abuse or neglect is not targeted at one specific individual, but a result of failures throughout the system in place at the home. Sometimes, neglect grows from understaffing homes to save money — staffers are simply too overwhelmed to give everyone the attention they need. As a result, they may start cutting corners or forgetting vital information about medication, feeding requirements and more. Cost-cutting measures can also lead to the hiring of workers with little training on the needs and legal rights of nursing home patients. As a Philadelphia medical malpractice lawyer, I believe patients deserve to be placed ahead of nursing home companies’ profits.
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As a Pennsylvania nursing home lawyer, I have watched with interest the progress of multiple lawsuits over the antipsychotic drug Risperdal (riperidone). The drug, made by Johnson & Johnson’s Janssen subsidiaries, is the subject of a federal lawsuit based in Massachusetts and numerous state lawsuits, all alleging that Janssen paid kickbacks to medical providers to promote the drug, thus defrauding Medicare and Medicaid, and downplayed negative safety information. This is especially disturbing because post-approval studies have shown that Risperdal carries a high risk of stroke, weight gain and related metabolic problems like diabetes. For this reason, it is no longer widely used off-label in dementia patients — one of the uses Janssen is alleged to have illegally promoted.

According to the Morristown, N.J., Daily Record, Pennsylvania Inspector General’s investigator Allen Jones noticed in 2002 that a computer program used by the state seemed to recommend Risperdal even when a less expensive medication would be appropriate. Jones couldn’t find any independent studies suggesting that Risperdal or other Janssen drugs were more effective than older generics, but the computer program, which doctors used to prescribe drugs, mandated them. Jones went public with his claims in 2004 and was fired. He is now an expert witness in a Texas state lawsuit alleging that the drug company defrauded the state’s Medicaid program out of many millions of dollars, through a similar computer program and questionable payments to doctors. A similar Pennsylvania lawsuit is on appeal, and ten other states and the federal government are also pursuing claims.

By the time Risperdal’s patent expired in 2007, it had generated $25 billion in profits for Janssen. It is approved for the treatment of patients with schizophrenia and bipolar disorder, and sometimes with autism. As a Philadelphia injury lawyer, I’m interested in the nursing home safety aspects of this story. The drug’s use to control dementia symptoms is off-label to start with, which means the company may not promote it for that use but doctors are free to prescribe it. This means offlabel marketing, including but certainly not limited to the Omnicare kickbacks, is already a violation of the law. However, independent studies have shown that Risperdal may increase the risk of death when used in dementia patients. In most cases, the death was cardiovascular in nature, which means heart failure, stroke or another serious medical emergency. As a result, the FDA required a black box warning on Risperdal’s label in early 2011. As a Philadelphia medical malpractice lawyer, I’m not sorry to see that the rate of new prescriptions for this purpose has plummeted since then. Not only is the risk too great, but the use to calm irritable dementia patients could be considered a form of Pennsylvania nursing home abuse — chemical restraints.
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I’ve written several times before on this blog about the local nursing home scandal centered around the Quadrangle nursing home in Delaware County. In May, I mentioned that the family of Lois McCallister announced plans to sue the Quadrangle’s parent company, Sunrise Senior Living, for negligence in the case. As a Pennsylvania nursing home lawyer, I was interested to see articles last week announcing that McCallister’s daughter and son-in-law, Mary and Paul French, have filed their suit. According to the Delaware County Daily Times, the Frenches filed their complaint Oct. 12 alleging that Sunrise negligently failed to train workers, negligently kept the home understaffed and failed to follow state regulations intended to protect vulnerable residents. They seek more than $50,000 in damages, but the Frenches said at a press conference that they really want to ensure that no other nursing home resident suffers in the same way.

The Frenches began to suspect the abuse after McCallister made comments suggesting it and even showed physical injuries. Quadrangle employees told them the complaints were probably a result of McCallister’s dementia, but Paul French bought a “nanny cam” disguised as a clock and put it in McCallister’s room. The resulting video showed three Quadrangle employees physically abusing McCallister, refusing to let her get dressed and making fun of her as she got upset. All three of them — Samirah Traynham, Ayesha Muhammed and Tyrina Griffin — have been fired and are awaiting a Nov. 14 trial on charges of assault, harassment and more. McCallister has since moved in with the Frenches, but Mary French said her mother still begs family members not to hurt her as they say goodnight. Paul French said at the conference that since the story went public, he’d gotten a letter from the husband of another Quadrangle resident, thanking them for the intervention because he believes care in the dementia unit is now better than it had been for the past two years.

As a Philadelphia injury lawyer, I am not at all surprised. When a media spotlight is shined on a nursing home, it frequently gets its act together, if only for the cameras. In this case, however, the Quadrangle was answering to state regulators as well: The state Department of Public Welfare revoked its license in April. That action was partly a reaction to McCallister’s abuse and the Quadrangle’s failure to report it, but articles at the time outlined other violations, including withholding prescribed medication, giving unprescribed medication, failure to conduct required employee background checks and more. A few years before, Sunrise had been disciplined for allowing dementia patients to consume paint and antibacterial cleaner. All of these forms of Pennsylvania nursing home abuse and neglect threaten the lives of people who are supposed to be cared for. As a Philadelphia medical malpractice lawyer, I suspect the French family’s lawsuit is right to ascribe many of the problems to cost-cutting — but for $8,000 a month, homes should do better.
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As a Pennsylvania nursing home lawyer, I frequently use witnesses to abusive behavior at nursing homes when my cases go to trial. Those witnesses are not always experts in what constitutes abuse; they are simply the people who happened to be nearby when the incident occurred. So I was interested to see a recent ruling from the Missouri Supreme Court saying the testimony of a non-expert witness is enough to prove that a nurse knowingly abused a patient. In Stone v. Missouri Department of Health Services, the complaint was actually from the nurse, Catherine Ann Stone, who was appealing a temporary disqualification from working that stemmed from allegations that she abused a patient.

Stone was a charge nurse at a nursing home; part of her job was to dispense medication to patients who needed it. In the incident underlying her case, she had to give medication to K.S., a female patient with dementia and mental disabilities who was known to become agitated and violent when receiving mediation. The instructions for K.S. said to leave her alone if this happened and try again later. On this occasion, after K.S. knocked a spoon away from her mouth and hit Stone in the shoulder, Stone asked a nursing assistant to restrain the arm. Stone then forced the spoon into the patient’s mouth, pushing her head forcefully against the back of a wheelchair. A dietary aide who witnessed this said K.S. was upset and crying, and took steps to calm her down rather than remove her from the dining room, as Stone instructed.

The dietary and nursing aides reported the incident and Stone was suspended, then fired. The incident was also reported to the state, which concluded that the incident was abuse and Stone would be disqualified from working as a nurse in Missouri for 18 months. Stone filed an administrative appeal, which she lost. She then appealed to state trial court, which reversed the decision, saying expert testimony was needed to show that K.S. suffered any physical or emotional harm. The state appealed.

The Supreme Court started by noting that the “injury or harm” necessary to find abuse is not defined by the statute or caselaw. However, previous nursing home abuse decisions had established that there is a low threshold for finding injury or harm, and that the mere fact of striking a patient necessarily involves injury or harm. In those decisions, expert testimony was not necessary. The same applies here, the Supreme Court said. Laypeople may testify as to what they experienced, and no special expertise is necessary to determine whether someone with mental disabilities is suffering. The court also found that Stone committed the abuse knowingly, because a reasonable person would have known that it would be emotionally distressing for K.S. to be held down and force-fed her medication, especially because she was known not to like her medication. Thus, the Supreme Court reversed the trial court and authorized the state to disqualify Stone from nursing for 18 months.

As a Philadelphia injury lawyer, I believe the court was right to find that a lay witness is enough to establish whether an action constituted abuse of a person with dementia. I believe most people would be emotionally distressed if they were physically held down and force-fed medication. A person with mental disabilities is not likely to feel differently about it, although it may be harder for that person to express it. In fact, judging by the facts laid out in this opinion, K.S. reacted with clear signs of fear and distress: screaming, crying and attempts to move away. Improper restraints are a clear type of Pennsylvania nursing home abuse, because they restrict the patient’s liberty and autonomy for the convenience of the nursing home’s staff. As a Philadelphia medical malpractice lawyer, I believe nursing homes can and should do better, even if it requires them to take a little more care.
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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.
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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.
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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.
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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.
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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.
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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.
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