Nursing Home Abuse

Most Elder Deaths in Nursing Homes are Never Investigated

January 2, 2012 | Lebowitz & Mzhen

Deaths occurring among elderly nursing home residents often escape scrutiny. Doctors may classify possibly suspicious deaths as the result of “natural” causes, and as a result cases of abuse and neglect are not investigated. Reporters for ProPublica, in cooperation with PBS’ “Frontline” and other news organizations, conducted a review of coroner and medical examiner records from around the country to examine how often suspicious deaths in nursing homes get swept under the rug. While an accurate total is probably impossible to determine, they identified over three dozen cases in which authorities missed “alleged neglect, abuse, or even murder of seniors.” The resulting article names three systemic problems in elder care that contributes to the problem of under-reporting suspicious deaths: incorrect identification of causes of death, completion of death certificates by doctors who did not examine the body, and infrequent autopsies of elderly decedents.

The authors of the study describe the case of Joseph Shepter, a resident of a California nursing home who passed away in 2007. The chief medical officer stated that his death resulted from heart disease, and the coroner never investigated. Around the time of his death, a staffer at the nursing home reported to state officials that the home was using antipsychotic drugs to “chemically restrain” dementia patients. This led to a fine against the home and an investigation by the state attorney general, including a look at the circumstances of Shepter’s death.

The investigation found widespread abuse and neglect, particularly with regard to Shepter. He had apparently lost nearly twenty percent of his body weight in the three months prior to his death. His cause of death was revised from heart failure to a combination of conditions related to neglect, such as dehydration, sepsis, and pneumonia, all made worse by the use of antipsychotic medications. Two years after Shepter’s death, prosecutors brought criminal charges for homicide against the chief medical officer and two others. His case helps illustrate the three systemic problems identified in the report.

1. Incorrect Causes of Death. States tend to rely on treating physicians to determine whether or not a death is “suspicious” or “natural.” If a treating physicians certifies a death as resulting from natural causes, coroners will not conduct an investigation. The law does not generally consider the possibility that a doctor would incorrectly identify, or even deliberately misstate, the cause of death.

2. Death Certificates, Sight Unseen. Many states allow doctors to complete a death certificate without examining the decedent’s body. Obvious physical signs of abuse or neglect may go entirely unnoticed.

3. Autopsy Ageism. The study found that autopsies are performed on elderly people in ever-decreasing numbers. In one sense, this is rational. The death of an elderly person, while tragic, is neither uncommon nor entirely unexpected, as opposed to the death of a younger person. As a result, elder deaths are often attributed to existing health conditions without much review, leading to physical evidence being overlooked.

Nursing Home Abuse Leads to Fines, Lawsuits in Michigan

December 27, 2011 | Lebowitz & Mzhen

Allegations of neglect and abuse in three different Michigan nursing homes have led to fines, firings, and lawsuits. Investigations uncovered horrific conditions in all three, including patient abuse, lack of proper hygiene and sanitation, and possible whistle-blower retaliation. The Michigan Protection and Advocacy Service (MPAS) reviewed nursing homes in sixteen counties and made recommendations to improve patient safety and quality of care. A different investigation by the federal Centers for Medicare and Medicaid Services (CMS) gave at least one nursing home its lowest possible ranking, jeopardizing its eligibility for federal funding.

The MPAS reported a case at the Whitehall Healthcare Center of Ann Arbor, located in Pittsfield Township, in which a woman’s catheter was found to contain maggots. The woman survived, but had to be rushed to the hospital for treatment. Three certified nursing aides formerly employed by Whitehall filed suit against Whitehall’s owner, LaVie Management Services of Tampa, Florida, claiming that they were fired in retaliation for reporting the abuse and neglect and neglect of several patients. One alleges retaliation after reporting a patient’s fall to state authorities, and the other two were allegedly fired for discussing the maggot incident with investigators. Their suit further alleges that the nursing home suspended several employees, including two of the plaintiffs, in order to prevent them from cooperating with the investigation of the maggot incident.

State authorities ultimately found that Whitehall failed to provide adequate supervision to two residents in wheelchairs, which resulted in injuries to both of them; failed to provide adequate catheter care to the resident described above; and failed to provide several other necessary services. The state now says that all the problems noted in their reported have been remedied. The former employees’ lawsuit is still pending.

In another case, this one at Cambridge South Nursing Home in Beverly Hills, outside of Detroit. A female resident was found to have maggots in her trachea. She was also hospitalized and survived. After an investigation by the MPAS, the Department of Labor and Regulatory Affairs fined the nursing home. The MPAS cited the two examples of maggot infestations to recommend a prohibition on hiring people with a verified history of complaints involving neglect or abuse, as well as a law requiring staff to report cases of abuse and neglect.

A CMS investigation of Borgess Gardens nursing home in Kalamazoo uncovered evidence of patient abuse, including a case in which nursing staff caused bruising and muscle and ligament injuries while trying to force a patient’s legs apart in order to catheterize the patient. The CMS inspection gave the nursing home a ranking of “4,” the lowest ranking on its scale of quality of care. It has added the nursing home to its Special Focus Facilities list, meaning it risks losing Medicare and Medicaid funding if it does not improve conditions.

Drug Tampering by Nurses Reveals Problems in Regulation and Hiring

December 21, 2011 | Lebowitz & Mzhen

A Kansas nurse accused of tampering with nursing home medications pleaded guilty to one count of adulteration of a drug and one count of consumer product tampering in a Topeka federal court at the end of November. Melanie Morrison admitted to diluting morphine solutions at the nursing home in Salina where she worked. The nursing director noticed that the caps had been removed from several vials of medication, and that the rubber covers had puncture marks indicative of a hypodermic needle. Morrison would mix sodium chloride into morphine sulfate, which reduced the painkiller’s effectiveness. She would also outright replace morphine vials with sodium chloride and take the morphine home. This put patients at risk, as some elderly patients can react very badly to sodium chloride solution. She admitted that she acted with “reckless disregard and extreme indifference” to the risks to the patients in her care.

Morrison’s plea deal could result in a prison sentence of up to three years. She has also surrendered her nursing license and agreed never to work in health care again. Prosecutors are asking that she go into a treatment program for drug addiction. If she completes the program, she could qualify for early release from prison.

The Kansas City Star notes that Morrison’s case illustrates an alarming problem with Kansas’ nursing regulations. According to news reports, Morrison had previously lost a job at a Wichita hospital for stealing the painkiller Percocet. Within months, she had a new job at a nursing facility with full access to the drug supply. The Star notes other similar cases. A nurse convicted of stealing patients’ drugs at an Emporia nursing home later found a job at a home in Topeka. There, she was caught diluting a patient’s painkiller with tap water. A nurse who diluted morphine solutions for several patients in Halstead had a previous conviction for prescription forgery.

The problem, according to the Star, is that Kansas law does not require nursing homes to conduct background checks on nurses and other medical professionals. The state nursing board obtained authority to conduct background checks on new nursing licensees, but not renewals, a mere three years ago. Nursing homes and hospitals therefore have no effective means if learning of any criminal or drug abuse history of their nurses. With regard to employees who regularly handle powerful narcotic medications, with patients in delicate medical condition, this would be useful information for nursing home administrators to have.

Nursing Home Aide Pleads Guilty to Seven Counts of Abuse After Hidden Camera Catches Her

December 14, 2011 | Lebowitz & Mzhen

A former nursing home aide in Ohio has pleaded guilty to seven criminal charges related to evidence that she abused a patient in her care. Another aide is scheduled to go to trial in January on one count of abusing the same patient. Evidence of abuse was captured on hidden cameras placed by the resident’s son in her room. At least four employees of the nursing home lost their jobs as a result of alleged abuse of this particular resident.

According to reporting by the Cleveland Plain Dealer, Steve Piskor moved his mother, Esther Piskor, into a nursing home operated by MetroHealth Medical Center in March 2009. He quickly became concerned about her condition and the quality of care the nursing home was providing to her. He made daily visits to her and reported finding her sitting in her wheelchair in soiled clothing and with unusual markings on her face. He made four complaints to the nursing home over the next two years, all of which he says met with little to no response.

Piskor placed a camera in his mother’s room in plain view, but workers reportedly placed a towel over it when they entered the room. In April 2011, Piskor took it upon himself to install a hidden camera in her room, with a posted notice indicating the camera’s presence, but not its location. Within two days, he says he had evidence of abuse.

He notified the nursing home administration, as well as Cleveland police. Police brought charges against several employees shown in the videos, and the Ohio attorney general’s office has gotten involved as well. Piskor’s attorney expressed concern at the apparent lack of concern among many administrators upon seeing the videos. MetroHealth has stated that one aide, the one who just pleaded guilty to seven criminal offense, was suspended less than thirty minutes after administrators reviewed the videos. The company declined to comment to the media, but issued a statement apologizing for the treatment of Esther Piskor and noting that several employees had been terminated.

Among the instances of abuse caught on camera are rough handling of Esther Piskor, aides shoving her into a chair, and pushing a hand into her face. Another aide is shown spraying something in her face. Piskor moved his mother to a different nursing home in September 2011.

Two Nursing Home Workers Lose Licenses After Alleged Beating of Resident

December 7, 2011 | Lebowitz & Mzhen

Two workers at a Staten Island nursing home lost their licenses as a result of the beating of a developmentally disabled resident. They also pleaded guilty to violating state health laws, and neither will work in health care again. The home itself was reportedly not cited with any violations. The state attorney general’s office reports that an aide allegedly struck a patient on the head several times, and a supervisor then allegedly tried to cover it up. The incident underscores the importance of vigilance among loved ones of nursing home residents.

According to a report in the Staten Island Advance, an EMT reported to a nurse supervisor that he witnessed an nurse aide hitting a patient on the head several times, and saw the patient react defensively. The patient was a developmentally disabled 40 year-old suffering from depression and schizophrenia. The nurse supervisor told the EMT not to report what he saw because, according to authorities, she did not want the aide to get into trouble. The nurse supervisor also reportedly did not examine the patient or file an incident report, although the law requires her to do so.

The state attorney general’s Medicaid Fraud Control Unit investigated the incident and charged the nurse aide with endangering the welfare of an incompetent or physically disabled person and with willfully violating state health laws. The aide pleaded guilty to the charge of willful violation of health laws, receiving a sentence of a conditional discharge. She had to give up her nurse aide certificate and may not work in health care as a further condition.

The nurse supervisor was charged with falsification of business records and with willfully violating state health laws. She also pleaded guilty to the willful violation charge and got a conditional discharge. She lost her practical nurse license and must refrain from working in health care. News reports indicated she had received two suspensions previously, once in 2004 for failing to report a patient’s fall or treat the patient’s injury, and in 2006 for administering an incorrect dosage of painkiller and attempting to hide the mistake.

Allegations of Illegal Pharmaceutical Marketing Rarely Lead to Penalties for Doctors

October 25, 2011 | Lebowitz & Mzhen

A recent review by the Washington Post of lawsuits against pharmaceutical companies shows that drug manufacturers pay billions in settlements and criminal penalties for irregular and illegal marketing of prescription medications. Doctors who participate in the marketing schemes, usually by accepting kickbacks for prescribing particular drugs, however, rarely if ever receive any punishment. This presents a concern for nursing home residents and their advocates. While the big drug companies present deeper pockets and higher-profile targets for regulators, doctors work on the front lines, so to speak, and have the greatest ability to assess the need for particular drugs. Ultimately, the decisions of doctors have the capacity to do the most harm to patients in these situations.

This Maryland Nursing Home Lawyer Blog has reported earlier on a complaint by the U.S. Department of Justice against Johnson & Johnson regarding alleged kickback payments to a large pharmacy for sales of antipsychotic medications like Risperdal. The suit alleged that J&J’s actions violated warnings from the Food and Drug Administration regarding the accuracy of Risperdal’s marketing materials. Drug manufacturer Eli Lilly pleaded guilty in 2009 to illegally marketing the antipsychotic drug Zyprexa to elderly patients. Accusations of marketing fraud regarding prescription medications and outright kickbacks to pharmacies and doctors in exchange for promoting certain drugs have hit at least fifteen pharmaceutical and medical device companies in the past few years.

The liability for illegal marketing and payment of kickbacks can be substantial for these companies. Eli Lilly paid $1.4 billion for penalties in the Justice Department’s case and settlements in four separate lawsuits related to Zyprexa. Alpharma paid $42.5 million in settlements related to allegations of kickbacks for prescribing the painkiller Kadian. Overall, accusations of marketing fraud and kickbacks have cost the industry $6.5 billion since 2008
The review of these cases found no instances of doctors facing serious sanctions or even professional discipline. Since 2008, federal investigations into kickbacks and illegal marketing have identified 75 doctors who allegedly participated. None received any sort of monetary or other criminal penalty. Few state medical boards conducted investigations into the doctors’ conduct. Many of the doctors allegedly involved say they have been unfairly labeled as key players in these schemes, when in fact they also rely on the drug companies for information on potential uses of their products. Still, doctors should approach any off-label use (i.e. any use not explicitly approved by the FDA) with caution.

Investigation Finds New York Caregivers for Mentally Disabled Rarely Lose Their Jobs, Even in Cases of Wrongdoing

October 11, 2011 | Lebowitz & Mzhen

A study conducted by the Poughkeepsie Journal has found that the state of New York has only succeeded twice in twenty attempts since 2007 to fire employees at local state-run facilities that care for the developmentally disabled. The Journal reviewed 1,900 pages of documents relating to disciplinary proceedings for 98 group homes and 6 institutions throughout the state. It found that only two percent of disciplinary actions since 2007, eight out of 341, resulted in firing, even in cases involving serious allegations of neglect or abuse.

Examples from the study of people who kept their jobs included a female staffer who held a patient by the hair and, while jabbing the patient in the face and yelling obscenities, forced the patient to drink an unknown liquid. Another case involved an aide who held a patient down on the ground by kneeling on the patient’s back and grabbing at the patient’s face, and who then tried to coerce a coworker into altering the report. That worker faced an assault charge in criminal court.

Not all workers involved in these cases actually remained at their facilities. The study found that many accepted resignation or unpaid suspensions, which keeps them on the payroll and has far less public impact than outright termination. It also allows for the possibility that individuals with disciplinary history, which might include abuse and neglect, may be able to obtain employment in homes for the developmentally disabled again in the future.

This situation in New York state underscores the importance of remaining educated about nursing homes, assisted living facilities, and other group care facilities to which you might entrust a loved one. These facilities clearly have an obligation to provide diligent and competent care, since they provide nearly all the daily needs of the residents.

In Maryland, facilities caring for people with developmental disabilities, which may include autism or Down syndrome, are regulated by the Developmental Disabilities Administration. It is part of the Office of Health Care Quality in the Maryland Department of Health & Mental Hygiene. Regulatory compliance is handled by the Developmental Disabilities Unit, which has established a system for complaints regarding misconduct in regulated facilities. Facilities providing full-time care to people with developmental disabilities must be licensed by the state, and reports of abuse, neglect, or misconduct certainly factor into licensing decisions.

Indictments Issued in Two Separate Maryland Nursing Home Assault Cases

October 4, 2011 | Lebowitz & Mzhen

Two recent incidents involving assaults on Maryland nursing home residents have led to indictments for abuse and assault. The incidents occurred in different facilities in nearby towns, but both involve nursing home employees allegedly assaulting vulnerable residents. The cases demonstrate the importance of vigilantly protecting the rights of nursing home residents who may find themselves helpless against the unscrupulous or criminal behavior of a few employees who might take advantage of that helplessness.

In the first case, a caregiver at a nursing home in Lutherville, Maryland is accused of stealing $80 from a blind 94 year-old resident, as reported by the Lutherville-Timonium Patch. According to court documents, the employee entered the resident’s room by pretending to be a different employee who had come to turn on the air-conditioning unit. She asked the resident, who in addition to being blind needs a hearing aid, to borrow money. The man told her no, at which point she allegedly tried to take his wallet from his pocket. She threw him out of his bed and onto the ground when he resisted her. When the man screamed for help, another employee intervened.

The employee denied allegations of theft and assault to police investigators that day. The next day, however, she turned herself in to the police. She has been charged with robbery, theft, and second-degree assault. She has also lost her job at the nursing home. The nursing director told the newspaper that if she is convicted, the Maryland Board of Nursing could take steps to keep her from ever working in a nursing home again. The robbery charge is a felony, assault in the second degree and theft of less than $1,000 are misdemeanors. She faces up to 15 years imprisonment for the robbery charge alone.

The second case involves a nursing home in Timonium, Maryland. A geriatric nursing assistant has been charged with abuse of a vulnerable adult in the second degree, neglect of a vulnerable adult in the second degree, and assault in the second degree. Each charge is a misdemeanor under Maryland law. An investigation by the Medicaid Fraud Control Unit, part of the Maryland Attorney General’s office, and the Maryland State Police originated from a referral from the Baltimore County Police Department. The alleged assault occurred in October 2010. Fewer details are available on this case, since it has only recently been filed. The employee is alleged to have assaulted an 84 year-old resident of the nursing home. Each of her charges are misdemeanors, and she faces up to 10 years in prison.

“Granny Cam” Technology May Be Effective at Deterring Nursing Home Abuse

September 20, 2011 | Lebowitz & Mzhen

The use of surveillance cameras to monitor treatment of elderly patients by nursing home staff, sometimes known as “granny cams,” is becoming more and more common in Maryland and around the country. While granny cams raise some concerns about the privacy rights of the patients, they have proven to be effective at exposing abuse that might have otherwise gone undiscovered, and state legislatures and agencies are taking notice.

This Maryland Nursing Home Lawyer Blog has previously reported on incidents when granny cams provided evidence of abuse, including a New Jersey case in which the family of a nursing home patient have sued for wrongful death after finding footage of an employee removing the patient’s oxygen mask and hitting her, which they claim led to her death. An Ohio man captured evidence of nursing home staff slapping his Alzheimer’s-stricken mother, shoving her into bed and into her wheelchair, and slamming her against walls. Three nursing home workers in Pennsylvania were arrested when hidden camera footage showed them mocking a patient while forcing her to stand topless.

The nursing home industry has vigorously fought legislative efforts to compel nursing homes to allow placement of cameras in patients’ rooms. Privacy advocates, as well as doctors, have also opposed such legislation at times, arguing that placement of cameras could be used to violate patients’ privacy, considering that nursing home patients requiring assistance in performing daily routines may often appear undressed on camera. Nursing homes further argue that the use of cameras may erode the trust between patients and staff and act as an invitation to lawsuits without good cause. Nursing home reform advocates, however, increasingly favor legal requirements that nursing homes allow cameras.

Some states have passed legislation preventing nursing homes from blocking the use of cameras, although Maryland is not yet one of them. Former Maryland Delegate Sue Hecht introduced such legislation several times beginning in 2001, after she witnessed her mother, Vera, suffering abuse at the hands of nursing home staff. Several bills titled “Vera’s Law” did not make it out of their committees, but a bill passed in 2003, also titled “Vera’s Law,” that required the Maryland Department of Health and Mental Hygiene to develop guidelines that do opt to allow use of electronic monitoring devices with the consent of the patient or the patient’s guardian. The Department issued its guidelines on December 1, 2003, and those guidelines remain in effect today.

Former Schoolteacher Sues Nursing Home For Elder Abuse

August 30, 2011 | Lebowitz & Mzhen

Recently, our Baltimore nursing home abuse blog discussed the financial abuse of elders–a hugely under reported problem affecting around 3.5 million seniors around the country every year.

In recent nursing home abuse lawsuit news, a 68-year-old retired preschool teacher has sued a Seal Beach nursing home for elder abuse, alleging that as a resident, she was chemically restrained with drugs against her will, while the nursing home staff tried to take control of her retirement income.

According to the lawsuit, Marsha Davis lived in her own home until November of 2010, and suffered from many health issues, including diabetes. After collapsing at her home In the fall of 2011, Davis was reportedly hospitalized and then transferred to the Country Villa nursing home, for a three-month stay.

Davis alleges that while residing at the home, she was medicated with psychotropic drugs for chemical restraint against her will—allegations that were reportedly found to be true by state investigators in February. The lawsuit claims that after she was medicated to the point of being entirely disorientated, the nursing home stated that she was suffering from “cognitive impairment” and tried to collect her Social Security payments.

Although Davis has no immediate family members to act as an advocate on her behalf, a friend of hers reportedly intervened, and the medication was stopped. Davis was later transferred to another home where she remains today.