Articles Posted in nursing home negligence

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As a lawyer who specializes in Philadelphia nursing home abuse and neglect, I am constantly astounded by the lack of government control and outrage. How is it possible that so many facilities, not just here in Pennsylvania, but throughout the United States, allow residents to live in unsanitary conditions, to be overmedicated with the drugs, to suffer bedsores, and to endure indignities like fraudulent billing, identity theft, sexual mistreatment, and so forth?

Unfortunately, since Rosenbaum & Associates is an advocacy firm for victims who’ve been damaged by Pennsylvania nursing home neglect and abuse, we are not an exactly an objective news source. Thus, when we sound the alarm bells, our claims might be dismissed as partisan.

That’s why it’s important to look to objective assessments, such as a recent series of 14 reports collected and analyzed by “Operation Guardian” out in California. From January 2010 through March of this year, California’s Attorney General secretly sent investigators into nursing homes in Pasadena, Woodland Hills, and elsewhere in Southern California.

The stark results were released in the middle of July. Inspectors found all sorts of ghastly violations of human dignity:

• Improperly treated bed sores;
• Patients being improperly medicated or being put on psychotropic drugs, needlessly;
• Patients left to sit in their own urine and feces for hours at the time;
• Nurse/patient ratios that were ridiculously inadequate;
• Fraudulent billing;
• Poor end of life care;
• Dehydration and malnutrition — easily avoidable, too!;
• Inadequate fall prevention;
• And beyond.

The California Advocates for Nursing Home Reform (CANHR) called the investigation “hair-raising” and said “the reports demonstrate that some nursing homes are houses of horror with life threatening filthy conditions, lack of staff to perform core functions, and poor management.”

The California Association of Health Facilities (CAHF) tried to defend the industry as a whole, suggesting that the 14 facilities that proved dramatically noncompliant constituted a “small portion” of the facilities that care for 300,000 California patients annually. The California Advocates for Nursing Home Reform were not placated, however, and asked California’s Attorney General to act on the information to make serious and robust changes: to prosecute managers, members, and owners of nursing homes with both civil and criminal charges.

From California to Pennsylvania: Nursing Home Abuse And Neglect Is A Nationwide Problem
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As a Pennsylvania nursing home lawyer, I’ve kept a close eye on the issue of overuse of antipsychotics in nursing home patients. These powerful drugs are intended for use in people with serious mental illnesses, but they became popular in the past decade for “off-label” use to control the symptoms of dementia. That popularity plummeted more recently, when medical studies began showing an elevated risk of death or serious health problems like strokes among elderly dementia patients taking the drugs. A recent investigative series of stories from the Boston Globe reports that 185,370 Medicare and Medicaid patients took antipsychotics for inappropriate reasons in 2010, down dramatically from 237,510 in 2005. However, the data from the federal Centers for Medicare and Medicaid Services also showed that those homes that do continue using the drugs inappropriately tend to be understaffed.

The newspaper compiled a database using the federal data, which allows families considering nursing homes to look up each home’s use of antipsychotics. The database excludes homes with fewer than 50 residents, but includes 15,600 homes of 50 or more, from across the United States. Of those homes, 21 percent were giving inappropriate antipsychotic medications to a quarter of their residents or more. Even more tellingly, the newspaper found “a clear link” between low staffing levels and high use of antipsychotics. Homes that most often used the antipsychotics off-label had fewer registered nurses, who direct medical care, and nurses’ aides, who provide much of the hands-on care. The newspaper suggested that this is because lower staffing levels make it hard to find the time necessary to control the negative behaviors of dementia without drugs. By contrast, antipsychotics frequently have a sedative effect, leading some to call them “chemical restraints” in an analogy to the physical restraints homes once used.

This is a form of Pennsylvania nursing home abuse, as any Philadelphia injury lawyer will explain. All nursing home patients deserve to have their basic dignity respected, and that means not drugging them into insensibility or physically restraining them just because it’s convenient for the staff. Nor should this be done for the sake of profit for the nursing home’s parent company, which can save money on staffing by drugging patients and charging the cost of the drugs to Medicare or Medicaid. (Indeed, the Globe found homes that overused antipsychotics tended to have more patients enrolled in Medicaid.) But perhaps the worst thing about the practice of using antipsychotics in elderly dementia patients is that the drugs’ known side effects include a risk of death. In fact, the risk is clear enough that the FDA has ordered its strongest warning on the drugs’ labels, telling patients and doctors about the increased risk of stroke and serious cardiovascular problems for elderly patients with dementia. As a Philadelphia medical malpractice lawyer, I strongly suggest that patients and families trying to make a well-educated decision about nursing home care take advantage of the Globe’s report to determine which homes near them are misusing these powerful drugs.
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Last year, I wrote here about a very large jury verdict in West Virginia, for the family of a woman who died of alleged neglect after just 15 days in a nursing home. So, as a Pennsylvania nursing home lawyer, I was interested to see a new development in that case. According to WOWK, the parent company of the nursing home Heartland of Charleston has succeeded in having its appeal considered by the West Virginia Supreme Court. The company’s appeal granted a request to suspend enforcement of the trial court’s judgment while it considers whether there were errors in the jury verdict form used in the case. The case gained local media attention because the Kanawha County jury awarded $91.5 million to the family of Dorothy Douglas, finding she died at least in part because of neglect during her short stay at Heartland of Charleston.

The family had placed Douglas in Heartland as a temporary measure while they waited for a spot in a dementia-specific home to open up. She suffered from Alzheimer’s with dementia, Parkinson’s disease and other conditions, but was able to walk and talk a little before moving to the home. The family contended in its lawsuit that staff at Heartland neglected her needs so badly that she lost 15 pounds and became unresponsive during her stay there. Staff allegedly also confined her to a wheelchair, saying she was at risk of falls. Douglas died not long after her transfer out of Heartland. Her family says the cause of death was severe dehydration and other neglect, though the home and its lawyers point to the death certificate saying the cause of death was dementia. Her family’s attorneys argued that with a turnover rate of 112 percent, Heartland didn’t have the staff to care for Douglas or others properly; and that indeed, its business model revolved around keeping costs low by keeping staffing ratios low. It had more than double the state’s average number of citations from February 2010 to April 2011.

According to the article, Heartland and its for-profit parent companies are asking the state high court to consider alleged mistakes in a jury verdict form. The article did not discuss what those mistakes were or how they would affect the jury’s determination of the verdict. An attorney for the Douglas family said the nursing home companies had opposed another jury verdict form near the end of the trial, and ended up working from the family’s proposed verdict form. That attorney also said the defendants had improperly used the jury verdict form to bring up certain legal issues for the first time. This is not permitted in appeals of lawsuits, he noted; trial courts must be given a chance to hear objections and the reasons for them so it can correct mistakes. The article also mentioned that the Douglas case has driven controversy over whether medical-malpractice damage caps should apply to nursing home cases, with this court splitting from another county circuit court on the issue.

As a Philadelphia medical malpractice lawyer, I’d welcome an investigation of that issue. As a rule, plaintiffs in Pennsylvania nursing home abuse lawsuits don’t have to file medical malpractice claims, though some do; nursing home abuse claims are generally for negligence. Some nursing home defendants are not medical professionals and cannot be sued for medical malpractice in any case. Indeed, this is sometimes a problem with the care at a bad home — inadequate training or experience for the jobs staff members must do. I also look forward, as a Philadelphia injury lawyer, to hearing about the outcome of this jury verdict form appeal. If the family’s attorney is correct, much of the appeal will be simply disregarded by the West Virginia Supreme Court, making all of this much ado about not much.
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Punitive damages are an ongoing issue for Pennsylvania nursing home lawyers like me. Political movements for “tort reform” often ban or cap punitive damages, believing they are “free money,” but nothing could be further from the truth. Juries and judges may only award punitive damages when the injury was caused by egregious intentional acts or knowing disregard for the victim’s safety. They are designed for the rare cases when courts wish to deter the defendant from repeating the egregiously unsafe behavior. And of course, they’re not common. However, because they’re a political issue, courts may set a higher bar for considering them. That was what happened in Estate of Henry Gibson v. Magnolia Healthcare, Inc., a Mississippi Supreme Court decision. The estate challenged the court’s decision not to allow consideration of punitives, as well as the constitutionality of the state’s noneconomic damages cap.

Henry Gibson was 71 when he suffered a stroke and seizures that left him bedbound and incontinent, with trouble communicating and serious underlying health conditions like diabetes and high blood pressure. His family sought care at Arnold Avenue Nursing Home in Greenville, Miss. Gibson was overweight when admitted, so his family may not have seen a red flag when he lost 40 pounds during his year and a half at AA, while he was using a feeding tube. However, he was hospitalized on December 31, 2002 for difficulty breathing, and hospital staff discovered a collection of fluid and blood around his lung as well as a broken arm. Both were attributed to a fall, an unusual circumstance for a bedbound patient. Gibson’s family transferred him to another home, but he died on Jan 26, 2003, of sepsis contributed to by the broken arm and a hematoma of the lung.

The estate sued, arguing that AA was negligent for leaving Gibson’s bedrails down, allowing the fall; allowing two bedsores to develop by failing to turn him, then failing to prevent them from getting worse; failing to ensure he got the recommended feeding tube, causing malnutrition and dehydration; and failing to perform range-of-motion exercises to prevent him from losing use of muscles. They offered evidence that AA was short-staffed and had left bedrails down in the past, as well as failed to document Gibson’s care. Despite arguments from the nursing home that there was no proof of a fall, the jury found for the estate and awarded $1.5 million, which the judge reduced to $575,000 due to a state cap on noneconomic damages. The estate also moved to allow the jury to consider noneconomic damages, but the judge denied this, finding evidence did not support a finding that AA’s conduct was not “sufficiently egregious or offensive.”

The estate appealed both the punitive damages decision and the state damages cap, arguing that it was unconstitutional. The Mississippi Supreme Court ultimately disagreed on both counts. The argument about the constitutionality of the statutory damages cap was rejected quickly, because the high court found that the estate had never raised the issue in trial court. Thus, it said, the issue was waived for consideration on appeal. But it did examine whether punitive damages should have been considered. Punitive damages are awarded in Mississippi when the defendant behaved with malice, actual fraud or gross negligence showing willful or reckless disregard for others’ safety. The high court said the evidence presented by the estate, which relied on the same evidence used for compensatory damages, was insufficient to show this. Thus, it upheld the trial court’s decision.

As a Philadelphia medical malpractice lawyer, I suspect the outcomes of both appeals might have been different in another state. In fact, some state high courts, including Arkansas and Georgia, have already ruled that punitive damages caps are unconstitutional (according to their own state constitutions). Because the Mississippi Supreme Court found the issue was waived, it didn’t truly address this issue and may well revisit it in the future. As for allowing the jury to consider punitive damages, I wish the court had gone into detail on its reasoning. The kind of underfunding alleged by the estate, along with the history of leaving bed rails down, could well form the basis of a finding of reckless disregard for safety. As a Philadelphia injury lawyer, I ask for punitive damages whenever I feel state law and the circumstances warrant.
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As a Pennsylvania nursing home lawyer, I was interested to see a nursing home negligence case that was sent back for a new trial that included evidence not previously presented. In Bedell v. Williams, the Arkansas Supreme Court also removed one defendant from the case, finding that the leader of the nursing home’s governing body could not be sued in his personal capacity. The victim was Minnie Lee Valentine, who died after two extended stays at Little Rock Healthcare, a nursing home, and trips in and out of other care facilities. Valentine had suffered a severe stroke before entering the home and had a slight pressure sore when she arrived, but that sore worsened as time went on. Before her death, Valentine suffered amputations related to other pressure sores as well.

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

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

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

As a Philadelphia medical malpractice lawyer, I’m disappointed that this victim’s estate and loved ones will have to retry the same case again. This is not just a delay for them, though these delays can be hard on suffering families; it is also an additional expense. Worse, it will not necessarily lead to the same result for them. This case may have been especially vigorously litigated because the verdict was very high, but — as many nursing home companies know — verdicts are often very high in cases of Pennsylvania nursing home abuse. Understandably, juries are not impressed by nursing homes that permit, ignore or even encourage abusive conduct and severe neglect of their patients. Patients like Valentine, who was dependent on full-time nursing, are at especially great risk from uncaring or lazy caregivers. As a Philadelphia injury lawyer, I am proud to help families fight this kind of negligence when it happens in the name of profit.
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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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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 was interested to see a nursing home decision from next door in Delaware. In Dishmon et al. v. Fucci et al., Michael Dishmon and others sued a nursing home for alleged malpractice leading to the death of his father. Dishmon filed an affidavit of merit, as required by Delaware law, as to the validity of his claims. However, the filing did not include a copy of the expert’s C.V. (professional resume), and the trial court dismissed the case on that basis. The Delaware Supreme Court reversed it, finding that the lack of a C.V. was a procedural error only and that the trial court should have used its discretion to allow the C.V. to be filed at a later date.

James Dishmon entered the Hockessin Hills nursing home in late December of 2004 with a variety of medical problems, including heart problems. Four days later, he died of acute coronary ischemia and coronary artery disease. His son, Michael Dishmon, alleges that contrary to his express instructions, Dr. Pasquale Fucci and his physician’s assistant, Bernie Schneider, put a “do not resuscitate” order on his father. Thus, the Hockessin Hills staff made no effort to revive the elder Dishmon when he fell ill. Michael Dishmon sued in December of 2006 and timely filed an affidavit of merit written by Dr. Herbert Muncie, which defendants moved to review in camera. That review led the judge to dismiss the case for three reasons: It did not contain a copy of Muncie’s C.V.; it didn’t demonstrate familiarity with the standard of care for a physician’s assistant; and it didn’t go into enough detail on Muncie’s opinion. Dishmon moved for relief from the judgment within two weeks, attaching the missing C.V., but the trial court denied it without comment four months later.

Dishmon appealed, challenging all three grounds for dismissal. The Delaware Supreme Court started with the issues of Muncie’s detail and familiarity with the physician’s assistant standards. Though Delaware’s affidavit of merit statute is designed to prevent frivolous lawsuits, the court said, its requirements are “purposefully minimal.” Thus, it found that Muncie’s affidavit was legally sufficient because it met the requirements of Delaware state law: “The General Assembly did not intend a minitrial at this stage of the litigation.” Thus, the defendants were wrong to argue that Muncie needed to demonstrate special familiarity or evidentiary support to file a legitimate affidavit. The high court next turned to the C.V., which it suggested the trial court may not have dismissed if it hadn’t found other parts of the affidavit insufficient. Delaware public policy favors allowing lawsuits to continue, it said. And trial courts have discretion to allow litigants to cure procedural mistakes. Thus, the trial court should have used its discretion to allow Dishmon to cure the mistake — particularly in light of the requirement that the C.V. be submitted in a sealed envelope, leaving the attorney no chance to double-check its contents. Finally, the high court urged trial judges to supply reasoning for their decisions, which was absent in this case.

Though the court is reserved in its disapproval, this case still seems like a victory to me as a Philadelphia injury lawyer. In essence, the high court found that the trial court dismissed the case arbitrarily and, for the first two reasons, for reasons contrary to the law. Plaintiffs are required to file these affidavits in many states, including Pennsylvania. While the requirements differ from state to state, the same principle applies: Litigants should not be required to go beyond the requirements of the statute in order to keep their cases alive. Indeed, these statutes are themselves special requirements that don’t apply to other kinds of lawsuits and were likely put in place for political reasons, requiring families that suffered from Pennsylvania nursing home abuse to jump through extra hoops. As a Philadelphia medical malpractice attorney, I vigorously fight to ensure my clients’ cases aren’t dismissed with arbitrary court rulings.
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As a Philadelphia injury lawyer, I was disappointed to see that a Philly-area nursing home is getting national attention for the wrong reasons. As the Philadelphia Inquirer reported Oct. 29, the U.S. Centers for Disease Control and Prevention called out a Montgomery County nursing home for having “one of the largest and most prolonged” outbreaks of streptococcus infections in a nursing facility. The CDC report did not name the home, but the Inquirer determined that the home is Arista Care at Meadow Springs in the town of Plymouth Meeting, and an administrator there confirmed the outbreak. In all, 13 residents had invasive strep and 10 had noninvasive strep. The CDC urged all long-term care facilities to investigate even a single case of strep and ensure they have good practices for controlling infections.

Two people died at Arista Care, but the home disputes that the cases were directly linked to strep. However, the CDC and the Pennsylvania health department both had records of multiple infection control problems at Arista Care, including ineffective “hand-hygiene practices.” State records showed that not every room had gloves and that the facility had housekeeping problems. The outbreak started in October of 2009 and was likely carried into the facility by more than one source, the article said. Near the beginning, admissions to the facility were suspended for about two weeks while five people, including four workers, were treated for the infection. In April of 2010, Artsta Care hired a full-time worker whose job is infection prevention. The spokesperson also mentioned adding hand sanitizer dispensers to every room and testing each new patient for strep. A state spokesperson said there have been no new cases since December of 2010.

It’s a relief to hear that this home is getting praised by the state for taking the necessary steps to stop the outbreak. But as a Pennsylvania nursing home lawyer, I think it’s worth asking what kind of ineffective practices may have led to the outbreak in the first place. Infectious disease control is absolutely vital at nursing homes, because nursing homes combine two features that make outbreaks particularly risky: vulnerable older people and many people living in close quarters. Age and illness can both depress an individual’s immune system; once the infection takes hold, age makes the victim more likely to develop a complication like dehydration. And living in close quarters makes it very easy to spread an infectious disease like strep, which spreads through close contact between people. As a Philadelphia medical malpractice lawyer, I hope nursing homes take the CDC’s warning to heart, because the risk is severe.
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