Articles Posted in Pennsylvania nursing home news

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As a Pennsylvania nursing home lawyer, I was interested to see a case about an issue that’s relatively underreported: discrimination in nursing homes. According to the Allentown Morning Call, a Pennsylvania court has ruled in favor of a woman who said she was kicked out of a Walnutport nursing home when the staff discovered that she has HIV. G.D., who is 36 and also suffers from schizophrenia and bipolar disorder, ended up in a locked psychiatric ward because she had nowhere else to go. Her attorney said this was a textbook example of the harm discrimination causes. The Pennsylvania Human Relations Commission won a court judgment ordering Canal Side Care Manor and its owner, Lakshmi Kademani, to pay damages to G.D. and a fine to the state. In its ruling, the court also found that Kademani filed a frivolous appeal and was taking steps to hide her assets from the court.

G.D. went to Canal Side after her group home recommended more care than it could provide. She did not expressly tell Canal Side that she had HIV, but a Canal Side employee discovered it when asking what certain medications were for. Kademani, concerned abut HIV transmission through G.D.’s urinary incontinence, then gave G.D. 24 hours to leave. G.D.’s healthcare team told Kademani that there was no serious risk with proper precautions, which were already in place. Nonetheless, G.D. was kicked out, and because her family was unable to provide the care she needs, ended up in “lockdown” at a mental hospital. G.D.’s sister filed a complaint with the Pennsylvania Human Relations Commission, which eventually ruled for G.D., fining Canal Side $5,000 and ordering $50,000 more in damages to G.D. Canal Side and Kademani appealed. The Commonwealth Court was unimpressed with the appeal, finding that it was meritless, legally inadequate and intended to delay paying the damages. Thus, it ordered attorney fees for G.D.’s appeal as well.

As a Philadelphia injury lawyer, I’m pleased to see a decision upholding the rights of a woman with a limited ability to advocate for herself. As the article points out, the effects of the discrimination against G.D. were not minor. After she was evicted from the nursing home, her family tried for a month or more to provide care, even though they didn’t have the special expertise necessary for mental illness, HIV and incontinence. After that failed, G.D. ended up in a mental hospital, imprisoned and unable to live a full life. When nursing home patients stay in their homes, discrimination may still rob them of adequate medical care. For example, studies document that African Americans tend to be in different and lower-quality homes than white patients. This kind of indifference can easily lead to Pennsylvania nursing home abuse and neglect. As a Philadelphia medical malpractice lawyer, I believe our elderly and disabled people deserve better.
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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 was interested to see a recent news item about a nursing home in the Pittsburgh region facing a lawsuit. According to the Altoona Mirror, the family of Alfred Pelligrino has sued the Valley View Nursing Home of Blair County, alleging Pelligrino died of complications from an improperly treated bedsore. Pelligrino suffered from Pick’s disease, a neurological disorder that eventually leads to death, but does not put sufferers at high risk for pressure sores. Nonetheless, the family alleges that Valley View, which is county-owned but run by a private contractor, failed to take steps to prevent the sores, then failed to treat them before they caused an infection that led to kidney and heart failure. They are requesting payment of the medical expenses related to Pelligrino’s illness as well as damages for his pain and suffering and their loss.

When Pelligrino entered the home in July of 2009, he was using a wheeled walker and could talk to nursing home staff. He had no skin problems at the time. The first pressure sores showed up in October of that year, and he was taken to a local hospital’s wound clinic multiple times between then and January of 2010. The family transferred him to another home, the Hollidaysburg Veterans Home, in February of 2010, but the wounds did not improve. According to the lawsuit, Pelligrino’s bedsores were so deep that they needed surgery to heal. The open wounds caused an infection that triggered congestive heart failure, which in turn caused kidney failure. The family’s lawsut, filed on behalf of wife Virginia Pelligrino, charges Valley View with substandard care and failure to prevent the bedsores.

As a Philadelphia medical malpractice lawyer, I would be interested to read more about these allegations. Because Pelligrino was relatively mobile when he entered the home, he was tagged as a low-risk patient for pressure sores. It’s possible that this lulled the home’s employees into a false sense of security. It’s also possible that he became less mobile after entering the home, due to restrictions on his movements, health deterioration or inappropriate medication — which unfortunately is not uncommon. But whatever the reason, the risk of bedsores for nursing home patients is well known, and so is the relatively simple method of preventing them. Failure to take those steps is a form of Pennsylvania nursing home abuse and neglect (as would be the inappropriate drugs). As a Philadelphia injury lawyer, I hope any allegations of this kind of impropriety come out in the trial, so western Pennsylvania families can be warned about any potential risks.
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As a Pennsylvania nursing home lawyer, I was interested to read an appeals court opinion about a historic “home for the aged” in Pittsburgh. The Lemington Home for the Aged was originally founded in 1883 as a rest home for elderly African Americans — many of whom, at the time, were former slaves with limited means of making a living. The nursing home was relocated and expanded in 1983, after which it encountered financial trouble, staffing trouble and a series of health and safety violations that included the deaths of two patients in the home’s care. After the home eventually filed for bankruptcy, a group of unsecured creditors filed a lawsuit against the home’s directors and officers, alleging they breached their fiduciary duty by failing to act sooner. The district court dismissed In re Lemington Home for the Aged, but the Third U.S. Circuit Court of Appeals resurrected the claim.

The nursing home was unable to make as much money as expected in the 1980s and 1990s, in part because almost all its residents were on Medicaid. It received loans from the city of Pittsburgh, Allegheny County and private foundations, but ended up with $4 million in mortgage debt. To make matters worse, the federal government banned new admissions for a time in 1998, and the home’s administrator declined to address staffing problems. A chief financial officer hired in 2002 failed to perform basic tasks; for example, Medicare bills were not submitted, and several employees quit because they were not paid. The home’s Board lacked a treasurer during some of this time, ensuring no oversight. The administrator was frequently absent and not replaced. Furthermore, the home was cited for numerous safety deficiencies during this period, leading up to the June 2004 death of a patient whose resuscitation order was ignored, and December 2004 death that could have been caused by neglect.

The administrator proposed bankruptcy in May of 2004, but the board opted for a loan instead, eventually filing for bankruptcy 11 months later. A committee of unsecured creditors in that bankruptcy eventually filed an adversary proceeding against the home’s directors and officers, alleging breach of fiduciary duty and deepening insolvency. The district court granted summary judgment to the home, finding that the fiduciary duty claim was barred and the deepening insolvency claim had insufficient support. The creditors appealed.

The Third U.S. Circuit Court of Appeals reversed that decision, finding that there were fact issues sufficient to let the case survive beyond summary judgment. Pennsylvania law allows directors to rely in good faith on information provided by their officers, who in turn must act in good faith in their jobs. The creditors argued that the administrator and the CFO breached their duties of due care; and that the board had breached its duty of due are by relying on the administrator, not intervening with the CFO, and diverting funds supporting the closed home to another home with an overlapping board of directors. The Third Circuit found that the creditors’ evidence was enough to convince a reasonable jury that the administrator and CFO were not competent. This shows that the business judgment rule does not apply — that is, the board cannot be said to have used reasonable diligence if they ignored signs that their officers were incompetent. It also disagreed with the district court that the in pari delicato rule applied. This rule bars plaintiffs from going to the courts over wrongdoing that they themselves had a part in. However, the Third Circuit said, the creditors have presented substantial evidence that the board was acting in its own self-interest, rather than for the good of the nursing home, when it moved the home’s funding to another home its members also controlled. This is enough to present a genuine issue of material fact, the Third said, and thus it reversed summary judgment.

As a Philadelphia injury lawyer, I’m pleased that there will be some accountability for the board and the officers for apparent mismanagement of this home. A nursing home is not just a business or even a nonprofit; it is a home, and families entrust their vulnerable loved ones to it. By failing to take good care of basics like paying employees, the officers may have made Pennsylvania nursing home abuse or neglect more likely. After all, it’s hard to provide good care if you have constant turnover and low morale. And of course, at least two deaths did take place at the home that may be traceable to mismanagement and neglect. As a Philadelphia medical malpractice lawyer, I hope those two families are able to get the answers they deserve.
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As a Pennsylvania nursing home lawyer, I was concerned to read about an outbreak of a water-borne disease in two Pittsburgh-area nursing homes. According to the Pittsburgh Tribune-Review, residents at two facilities in Turtle Creek, in the Pittsburgh suburbs, were diagnosed with Legionnaires’ disease last week. Eight people fell ill at LGAR Health and Rehabilitation Center; three more patients were diagnosed at Hamilton Hills Personal Care Home. Three of the 11 patients had to be hospitalized. Because the disease is caused by a bacterium in water and spreads easily, both homes were using bottled water while they attempt to fix the problem and await test results.

Legionnaires’ disease is life-threatening, particularly for children and the elderly. Rates of death for people who develop it in hospitals are as high as 50 percent. It is an infection with the bacteria Legionella, which is inhaled as water vapor from sources like showers, air-conditioners and humidifiers. Once it’s in the body, victims develop a high fever and pneumonia-like symptoms that can include vomiting, diarrhea, confusion and even kidney impairment. No deaths in the Turtle Creek outbreaks were reported as of Sept. 15. However, the Tribune-Review added another victim to the total that day, reporting that the patient had previously been diagnosed with pneumonia. A spokesman for the Allegheny County Health Department said the department had already seen 50 or 60 cases this year. Nursing homes are especially vulnerable, he said, because they may keep their water temperatures low to avoid scalding fragile patients. LGAR had already heated and flushed its water, WTAE reported, and had also installed a special copper ionization system to prevent future outbreaks.

It’s pleasing to me as a Philadelphia medial malpractice lawyer that this nursing home is taking quick action to solve its Legionnaires’ problem. Because this disease is transmitted by inhaling, it’s not uncommon to see outbreaks affecting many, many people within range of the infected water supply. In a nursing home, a closed environment that patients rarely leave, this could mean an outbreak affecting nearly everyone in the home. And because the disease is especially hard on older people with health problems — the kinds of health problems that require nursing home care — a Legionnaires’ disease outbreak could be life-threatening. Medical authorities agree that the disease is relatively easy to prevent, by keeping water supplies at safe temperatures. As a Philadelphia injury lawyer, I don’t believe this is difficult for nursing homes to do — and could make a huge difference for nursing home patients.
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As a Pennsylvania nursing home lawyer, I was interested to read about a bill that could change the way nursing homes handle allegations of abuse, neglect and other regulatory violations. According to a June 12 article from the Standard-Speaker of Hazelton, a committee of the state Senate passed a bill last week that would give nursing homes the opportunity to hire an independent third party to investigate allegations against them by the state. The bill, if passed, would give homes the option to choose conventional investigation by the state Health Department or a third party investigator, which they would pay for themselves. It is backed by the Pennsylvania Health Care Association, a business group that represents nursing homes, and is being reviewed by the SEIU.

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

This bill is not law; it still has to pass both houses of the state legislature. As a Philadelphia injury lawyer, I hope that before legislators vote, they carefully consider what else the nursing home companies might be buying when they pay for their own inspections. Independent companies that depend on nursing homes for their business might find they have a financial incentive to come up with the results their customers want — no health violations. If the Health Department doesn’t have the time or resources to dispute this, it could allow hundreds of health code violations to go unaddressed. And while inspections would cost the homes money, that cost would likely be dwarfed by the cost of a single nursing home abuse lawsuit from a family using the state inspection results to prove there were problems at the home. As a Philadelphia medical malpractice lawyer, I also think it’s appropriate in some ways for the Health Department to have a “bias.” It should be biased in favor of whatever is safest for elderly and disabled Pennsylvanians, because accountability is an important tool for fighting Pennsylvania nursing home abuse.
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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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As a Philadelphia medical malpractice lawyer, I know that the spread of contagious disease is a major problem in nursing homes and hospitals. Contagious diseases are those that spread quickly from person to person, like the flu. Not surprisingly, they’re a problem in every living situation where many people are clustered together — but they’re an especially big problem in nursing homes, where residents are more likely to be elderly and unwell. Now, a new study from the University of Pittsburgh has found that about 15% of nursing homes across the U.S. are cited for problems in their infection control practices each year. The study drew from records of citations used by evaluators considering homes for Medicare or Medicaid certification, which almost every home must have.

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

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